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Cammarata F, Rovati L, Fontana P, Gambitta P, Armellino A, Aseni P. Endoscopic Ultrasound to Identify the Actual Cause of Idiopathic Acute Pancreatitis: A Systematic Review. Diagnostics (Basel) 2023; 13:3256. [PMID: 37892077 PMCID: PMC10606009 DOI: 10.3390/diagnostics13203256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/24/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Idiopathic acute pancreatitis (IAP) presents a diagnostic challenge and refers to cases where the cause of acute pancreatitis remains uncertain despite a comprehensive diagnostic evaluation. Endoscopic ultrasound (EUS) has emerged as a valuable tool in the diagnostic workup of IAP. This review explores the pivotal role of EUS in detecting the actual cause of IAP and assessing its accuracy, timing, safety, and future technological improvement. In this review, we investigate the role of EUS in identifying the actual cause of IAP by examining the available literature. We aim to assess possible existing evidence regarding EUS accuracy, timing, and safety and explore potential trends of future technological improvements in EUS for diagnostic purposes. Following PRISMA guidelines, 60 pertinent studies were selected and analysed. EUS emerges as a crucial diagnostic tool, particularly when conventional imaging fails. It can offer intricate visualization of the pancreas, biliary system, and adjacent structures. Microlithiasis, biliary sludge, chronic pancreatitis, and small pancreatic tumors seem to be much more accurately identified with EUS in the setting of IAP. The optimal timing for EUS is post-resolution of the acute phase of the disease. With a low rate of complications, EUS poses minimal safety concerns. EUS-guided interventions, including fine-needle aspiration, collection drainage, and biopsies, aid in the cytological analysis. With high diagnostic accuracy, safety, and therapeutic potential, EUS is able to improve patient outcomes when managing IAP. Further refinement of EUS techniques and cost-effectiveness assessment of EUS-guided approaches need to be explored in multicentre prospective studies. This review underscores EUS as a transformative tool in unraveling IAP's enigma and advancing diagnostic and therapeutic strategies.
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Affiliation(s)
- Francesco Cammarata
- Department of General Surgery, Ospedale Luigi Sacco, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Lucrezia Rovati
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Emergency Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Paola Fontana
- Department of Gastroenterology, ASST Ovest Milanese, 20025 Legnano, Italy; (P.F.); (P.G.)
| | - Pietro Gambitta
- Department of Gastroenterology, ASST Ovest Milanese, 20025 Legnano, Italy; (P.F.); (P.G.)
| | - Antonio Armellino
- Endoscopy Division, Ospedale San Leopoldo Mandic di Merate, ASST Lecco, 23807 Lecco, Italy;
| | - Paolo Aseni
- Emergency Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy
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Demirbaş F, Kaymazlı M, Çaltepe G, Abbasguliyev H, Kalaycı AG, Bektaş A. Endoscopic Ultrasonography in Pediatric Patients with Pancreatobiliary Disease: Single-Center Trial. Pediatr Gastroenterol Hepatol Nutr 2021; 24:164-172. [PMID: 33833972 PMCID: PMC8007838 DOI: 10.5223/pghn.2021.24.2.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/05/2020] [Accepted: 11/06/2020] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The use of Endoscopic ultrasonography (EUS) in pediatric patients is not as common as in adults. The aim of this study is to evaluate the role of EUS in the diagnosis of pancreatobiliary disease in childhood. METHODS Between December 2016 and January 2018, the findings of patients who underwent EUS were evaluated retrospectively. RESULTS Of the 41 patients included in the study 25 were girls (61.0%), mean age was 12.2±4.2 years. EUS was performed for biliary colic in 21 (51.2%), for recurrent pancreatitis in 12 (29.2%), for cholecystitis/cholangitis in 5 (12.2%), and for acute pancreatitis in 3 (7.4%) patients. EUS had a significant clinical effect in the decision of treatment and follow-up of 6/21 biliary colic cases, in diagnosis and follow-up of 6/12 recurrent pancreatitis cases, in decision-making and monitoring of invasive procedures (ERCP/surgery) of 3/5 acute cholecystitis/cholangitis and 2/3 of acute pancreatitis cases as well as in follow-up of the other cases. The effectiveness of EUS in determining direct treatment and invasive intervention was 43.9%. None of the patients had complications related to the EUS procedure. CONCLUSION Although current guidelines show that EUS can be used in pediatric patients, this is limited to a few published studies. In this study, it is shown that EUS is a safe method for the diagnosis, follow-up and treatment of common pancreatobiliary pathologies in childhood.
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Affiliation(s)
- Fatma Demirbaş
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Mustafa Kaymazlı
- Department of Gastroenterology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Gönül Çaltepe
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | | | - Ayhan Gazi Kalaycı
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Ahmet Bektaş
- Department of Gastroenterology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
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Suzuki M, Minowa K, Isayama H, Shimizu T. Acute recurrent and chronic pancreatitis in children. Pediatr Int 2021; 63:137-149. [PMID: 32745358 DOI: 10.1111/ped.14415] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/27/2020] [Accepted: 07/28/2020] [Indexed: 12/14/2022]
Abstract
Acute recurrent pancreatitis (ARP) is defined as two distinct episodes of acute pancreatitis (AP), whereas chronic pancreatitis (CP) is caused by persistent inflammation of the pancreas. In children they are caused by genetic mutations, autoimmune pancreatitis, congenital pancreatic abnormalities, and other conditions. Acute recurrent pancreatitis is frequently a precursor to CP, and both are thought to be on the same disease continuum. In particular, genetic factors are associated with early progression of ARP to CP. The diagnosis of CP, as in AP, is based on clinical findings, biochemical tests, and imaging studies. Findings of exocrine pancreatic dysfunction are also important in the diagnosis of CP. A step-up strategy has become increasingly standard for the treatment of patients with CP. This strategy starts with endoscopic treatment, such as pancreatic sphincterotomy and stenting, and progresses to surgery should endoscopic therapy fail or prove technically impossible. Non-opioid (e.g. ibuprofen / naproxen) and opioid (e.g. oxycodone) forms of analgesia are widely used in pediatric patients with AP or CP, whereas pancreatic enzyme replacement therapy may be beneficial for patients with abdominal pain, steatorrhea, and malnutrition. Despite the disparity in the age of onset, pediatric CP patients display some similarities to adults in terms of disease progress. To reduce the risk of developing pancreatic exocrine inefficiency, diabetes and pancreatic cancer in the future, clinicians need to be aware of the current diagnostic approach and treatment methods for ARP and CP and refer them to a pediatric gastroenterologist in a timely manner.
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Affiliation(s)
- Mitsuyoshi Suzuki
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kei Minowa
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
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Tepox-Padrón A, Bernal-Mendez RA, Duarte-Medrano G, Romano-Munive AF, Mairena-Valle M, Ramírez-Luna MÁ, Marroquin-Reyes JD, Uscanga L, Chan C, Domínguez-Rosado I, Hernandez-Calleros J, Pelaez-Luna M, Tellez-Avila F. Utility of endoscopic ultrasound in idiopathic acute recurrent pancreatitis. BMJ Open Gastroenterol 2021; 8:bmjgast-2020-000538. [PMID: 33402380 PMCID: PMC7786795 DOI: 10.1136/bmjgast-2020-000538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022] Open
Abstract
Idiopathic acute recurrent pancreatitis (IARP) is defined as at least two episodes of acute pancreatitis with the complete or near-complete resolution of symptoms and signs of pancreatitis between episodes, without an identified cause. There is a paucity of information about the usefulness of endoscopic ultrasound (EUS) in IARP.
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Affiliation(s)
- Alejandra Tepox-Padrón
- Gastrointestinal Endoscopy Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
| | - Rafael Ambrosio Bernal-Mendez
- Gastrointestinal Endoscopy Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
| | - Gilberto Duarte-Medrano
- Gastrointestinal Endoscopy Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
| | - Adriana Fabiola Romano-Munive
- Gastrointestinal Endoscopy Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
| | - Milton Mairena-Valle
- Gastrointestinal Endoscopy Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
| | - Miguel Ángel Ramírez-Luna
- Gastrointestinal Endoscopy Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
| | - Jose Daniel Marroquin-Reyes
- Gastrointestinal Endoscopy Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
| | - Luis Uscanga
- Gastroenterology Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico
| | - Carlos Chan
- Surgery Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
| | - Ismael Domínguez-Rosado
- Surgery Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
| | - Jorge Hernandez-Calleros
- Gastroenterology Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico
| | - Mario Pelaez-Luna
- Gastroenterology Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico
| | - Felix Tellez-Avila
- Gastrointestinal Endoscopy Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
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