• Devica S Umans, Hester C Timmerhuis, AntenMarie-Paule G FMGFDepartment of Gastroenterology and Hepatology, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands., Abha Bhalla, Rina A Bijlsma, Lotte Boxhoorn, Menno A Brink, Marco J Bruno, Wouter L Curvers, Brechje C van Eijck, G Willemien Erkelens, van GeenenErwin J MEJMDepartment of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands., Wouter L Hazen, Chantal V Hoge, Lieke Hol, Akin Inderson, Liesbeth M Kager, Sjoerd D Kuiken, Lars E Perk, Rutger Quispel, RömkensTessa E HTEHDepartment of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, the Netherlands., Christina J Sperna Weiland, Annemieke Y Thijssen, Niels G Venneman, Robert C Verdonk, Roy L J van Wanrooij, Ben J Witteman, Marc G Besselink, and Jeanin E van Hooft.
• Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands.
• Br J Surg. 2023 Nov 9; 110 (12): 187718821877-1882.

BackgroundCholecystectomy in patients with idiopathic acute pancreatitis (IAP) is controversial. A randomized trial found cholecystectomy to reduce the recurrence rate of IAP but did not include preoperative endoscopic ultrasonography (EUS). As EUS is effective in detecting gallstone disease, cholecystectomy may be indicated only in patients with gallstone disease. This study aimed to determine the diagnostic value of EUS in patients with IAP, and the rate of recurrent pancreatitis in patients in whom EUS could not determine the aetiology (EUS-negative IAP).MethodsThis prospective multicentre cohort study included patients with a first episode of IAP who underwent outpatient EUS. The primary outcome was detection of aetiology by EUS. Secondary outcomes included adverse events after EUS, recurrence of pancreatitis, and quality of life during 1-year follow-up.ResultsAfter screening 957 consecutive patients with acute pancreatitis from 24 centres, 105 patients with IAP were included and underwent EUS. In 34 patients (32 per cent), EUS detected an aetiology: (micro)lithiasis and biliary sludge (23.8 per cent), chronic pancreatitis (6.7 per cent), and neoplasms (2.9 per cent); 2 of the latter patients underwent pancreatoduodenectomy. During 1-year follow-up, the pancreatitis recurrence rate was 17 per cent (12 of 71) among patients with EUS-negative IAP versus 6 per cent (2 of 34) among those with positive EUS. Recurrent pancreatitis was associated with poorer quality of life.ConclusionEUS detected an aetiology in a one-third of patients with a first episode of IAP, requiring mostly cholecystectomy or pancreatoduodenectomy. The role of cholecystectomy in patients with EUS-negative IAP remains uncertain and warrants further study.© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

19 keywords...

hide…