Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2015; 21(36): 10427-10434
Published online Sep 28, 2015. doi: 10.3748/wjg.v21.i36.10427
Early endoscopic ultrasonography in acute biliary pancreatitis: A prospective pilot study
Andrea Anderloni, Marianna Galeazzi, Marco Ballarè, Michela Pagliarulo, Marco Orsello, Mario Del Piano, Alessandro Repici
Andrea Anderloni, Alessandro Repici, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
Marianna Galeazzi, Marco Ballarè, Michela Pagliarulo, Marco Orsello, Mario Del Piano, Gastrointestinal and Endoscopy Unit, AOU “Maggiore della Carità”, 28100 Novara, Italy
Author contributions: Anderloni A designed the study and actively participated to the execution of the endoscopic procedures; Galeazzi M and Pagliarulo M contributed collecting data and writing the paper; Ballarè M and Orsello M were involved in the endoscopic procedures and in following patients and collecting data; Del Piano M and Repici A contributed to the statistic and reviewed the paper.
Institutional review board statement: The study complied with the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the Institutional Review Board of our hospital.
Clinical trial registration statement: NCT02430285.
Informed consent statement: Written informed consent was obtained from all the patients enrolled.
Conflict-of-interest statement: None declared.
Data sharing statement: Consent for data sharing was not obtained but this was a single centre pilot study and the presented data are anonymized and the risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andrea Anderloni, MD, PhD, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, 20089 Milan, Italy. andrea.anderloni@humanitas.it
Telephone: +39-2-82242579 Fax: +39-2-82242292
Received: March 9, 2015
Peer-review started: March 10, 2015
First decision: April 1, 2015
Revised: May 12, 2015
Accepted: June 9, 2015
Article in press: June 10, 2015
Published online: September 28, 2015
Abstract

AIM: To investigate the clinical usefulness of early endoscopic ultrasonography (EUS) in the management of acute biliary pancreatitis (ABP).

METHODS: All consecutive patients entering the emergency department between January 2010 and December 2012 due to acute abdominal pain and showing biochemical and/or radiological findings consistent with possible ABP were prospectively enrolled. Patients were classified as having a low, moderate, or high probability of common bile duct (CBD) stones, according to the established risk stratification. Exclusion criteria were: gastrectomy or patient in whom the cause of biliary obstruction was already identified by ultrasonography. All enrolled patients underwent EUS within 48 h of their admission. Endoscopic retrograde cholangiopancreatography was performed immediately after EUS only in those cases with proven CBD stones or sludge. The following parameters were investigated: (1) clinical: age, sex, fever; (2) radiological: dilated CBD; and (3) biochemical: bilirubin, AST, ALT, gGT, ALP, amylase, lipasis, PCR. Association between presence of CBD stone at EUS and the individual predictors were assessed by univariate logistic regression. Predictors significantly associated with CBD stones (P < 0.05) were entered in a multivariate logistic regression model.

RESULTS: A total of 181 patients with pancreatitis were admitted to the emergency department between January 2010 and December 2012. After exclusion criteria a total of 71 patients (38 females, 53.5%, mean age 58 ± 20.12 years, range 27-89 years; 33 males, 46.5%, mean age 65 ± 11.86 years, range 41-91 years) were included in the present study. The probability of CBD stones was considered low in 21 cases (29%), moderate in 26 (37%), and high in the remaining 24 (34%). The 71 patients included in the study underwent EUS, which allowed for a complete evaluation of the target sites in all the cases. The procedure was completed in a mean time of 14.7 min (range 9-34 min), without any notable complications.The overall CBD stone frequency was 44% (31 of 71), with a significant increase from the group at low pretest probability to that at moderate (OR = 5.79, P = 0.01) and high (OR = 4.25, P = 0.03) pretest probability.

CONCLUSION: Early EUS in ABP allows, if appropriate, immediate endoscopic treatment and significant spare of unnecessary operative procedures thus reducing possible related complications.

Keywords: Acute biliary pancreatitis, Choledocolithiasis, Common bile duct stones, Endoscopic retrograde cholangiography, Endoscopic ultrasonography

Core tip: The decision to perform an endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) is often based on biochemical and radiological criteria despite they have been shown to be unreliable predictors of common bile duct stone presence. Endoscopic ultrasonography (EUS) has recently been proposed as the new gold standard in the diagnosis of choledocholithiasis. Accordingly, the present prospective pilot study was designed to investigate the clinical usefulness of early EUS in the management of ABP. Early EUS-guided ERCP is an accurate, safe and quick strategy as a first step in the management of ABP.