Letters To The Editor
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World J Gastrointest Endosc. May 16, 2013; 5(5): 273-274
Published online May 16, 2013. doi: 10.4253/wjge.v5.i5.273
Is idiopathic recurrent pancreatitis attributed to small stones?
Wai-Keung Chow, Yen-Chun Peng
Wai-Keung Chow, Division of Gastroenterology, China Medical University Hospital, Taichung 407, Taiwan
Wai-Keung Chow, Division of Gastroenterology, China Medical University, Taichung 407, Taiwan
Yen-Chun Peng, Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
Yen-Chun Peng, Division of Gastroenterology, National Yang-Ming University, Taipei 11221, Taiwan
Author contributions: Chow WK contributed to the concept and writing the manuscript; Peng YC contributed to the review and writing manuscript.
Correspondence to: Wai-Keung Chow, MD, Division of Gastroenterology, China Medical University Hospital, No. 2, Yu-Der Rd., Taichung 407, Taiwan. wkchow2010@gmail.com
Telephone: +886-4-23592525 Fax: +886-4-23741318
Received: October 24, 2012
Revised: February 6, 2013
Accepted: March 8, 2013
Published online: May 16, 2013
Abstract

Idiopathic recurrent pancreatitis remains a clinical challenge. Intraductal ultrasonography in the management of idiopathic recurrent pancreatitis may be a new strategy for undetermined causes after initial diagnostic approaches, including endoscopic retrograde cholangio-pancreatography (ERCP). However, no definite cause after ERCP should be defined under optimal settings and with experienced technique.

Keywords: Endoscopic retrograde cholangio-pancreatography, Idiopathic recurrent pancreatitis, Biliary stone

Core tip: The diagnosis of patients with idiopathic recurrent pancreatitis was revised after intraductal US used the criterion of 0.2-0.3 cm for common biliary duct stones. This implied that endoscopic retrograde cholangio-pancreatography (ERCP) could not be effective for identification of small biliary stones. For a more perfect ERCP study, an ERCP endoscopist should be aware that ERCP is a dynamic study, rather than image reading alone, and it should be possible to select an appropriate concentration of contrast medium for different conditions. Thus, even small stones could be detected without a second diagnostic tool.