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World J Gastroenterol. Oct 14, 2017; 23(38): 6952-6961
Published online Oct 14, 2017. doi: 10.3748/wjg.v23.i38.6952
Role of endoscopic ultrasound in idiopathic pancreatitis
Piyush Somani, Tagore Sunkara, Malay Sharma
Piyush Somani, Malay Sharma, Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut 25001, India
Tagore Sunkara, Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affliate of The Mount Sinai Hospital, Brooklyn, NY 11201, United States
Author contributions: Somani P wrote the manuscript; Sunkara T and Sharma M edited the manuscript; Somani P, Sunkara T and Sharma M designed the study.
Conflict-of-interest statement: Authors declare no conflict of interests for this article
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: Piyush Somani, MD, DM, Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Uttar Pradesh, Meerut 25001, India. dr_piyushsomani@yahoo.co.in
Telephone: +91-9320740518 Fax: +91-121-2657154
Received: August 12, 2017
Peer-review started: August 13, 2017
First decision: August 30, 2017
Revised: September 11, 2017
Accepted: September 20, 2017
Article in press: September 19, 2017
Published online: October 14, 2017
Processing time: 64 Days and 16.8 Hours
Abstract

Recurrent acute pancreatitis (RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. The initial evaluation fails to detect the cause of RAP in 10%-30% of patients, whose condition is classified as idiopathic RAP (IRAP). Idiopathic acute pancreatitis (IAP) is a diagnostic challenge for gastroenterologists. In view of associated morbidity and mortality, it is important to determine the aetiology of pancreatitis to provide early treatment and prevent recurrence. Endoscopic ultrasound (EUS) is an investigation of choice for imaging of pancreas and biliary tract. In view of high diagnostic accuracy and safety of EUS, a EUS based management strategy appears to be a reasonable approach for evaluation of patients with a single/recurrent idiopathic pancreatitis. The most common diagnoses by EUS in IAP is biliary tract disease. The present review aims to discuss the role of EUS in the clinical management and diagnosis of patients with IAP. It elaborates the diagnostic approach to IAP in relation to EUS and other different modalities. Controversial issues in IAP like when to perform EUS, whether to perform after first episode or recurrent episodes, comparison among different investigations and the latest evidence significance are detailed.

Keywords: Endoscopic ultrasound; Pancreatitis; ERCP; MRCP; USG; CT; Idiopathic recurrent pancreatitis; Ascariasis; Pancreatic cancer; Biliary sludge; Gallstones; Microlithiasis; Common bile duct stones

Core tip: The initial evaluation fails to detect the cause of recurrent acute pancreatitis (RAP) in 10%-30% of patients, whose condition is classified as idiopathic RAP. Idiopathic acute pancreatitis (IAP) is a diagnostic challenge for gastroenterologists. In view of high diagnostic accuracy and safety of endoscopic ultrasound (EUS), a EUS based management strategy appears to be a reasonable approach for evaluation of patients with a single/recurrent idiopathic pancreatitis. The most common diagnoses by EUS in IAP is biliary tract disease. This review aims to discuss the role of EUS in the clinical management and diagnosis of patients with IAP.