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Endoscopy 2020; 52(11): 955-964
DOI: 10.1055/a-1183-3370
Systematic review

Endoscopic ultrasonography can detect a cause in the majority of patients with idiopathic acute pancreatitis: a systematic review and meta-analysis

Devica S. Umans
1   Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
2   Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Carlos K. Rangkuti
1   Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
Christa J. Sperna Weiland
2   Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
3   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
,
Hester C. Timmerhuis
2   Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
4   Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Stefan A. W. Bouwense
5   Department of Surgery, Maastricht UMC+, Maastricht, The Netherlands
,
Paul Fockens
1   Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
Marc G. Besselink
6   Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
Robert C. Verdonk
7   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Jeanin E. van Hooft
1   Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
for the Dutch Pancreatitis Study Group › Author Affiliations
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Referred to by:

Diagnosis of idiopathic acute pancreatitis: the simpler, the better?Endoscopy 2020; 52(11): 965-966
DOI: 10.1055/a-1191-3053

Abstract

Background Idiopathic acute pancreatitis (IAP) has a 25 % pancreatitis recurrence rate. Endoscopic ultrasonography (EUS) may diagnose treatable causes of IAP and hence prevent recurrence. The goal of this systematic review with meta-analysis is to determine the diagnostic yield of EUS and its impact on recurrence.

Methods PubMed, EMBASE and the Cochrane Library were systematically searched for English studies on EUS in adults with IAP. The primary outcome was diagnostic yield. Secondary outcomes included recurrence. Methodological quality was assessed using the QUADAS-2 score. Meta-analysis was performed to calculate the pooled diagnostic yield and risk ratio with 95 % confidence intervals (CI) using a random-effects model with inverse variance method.

Results 22 studies were included, with 1490 IAP patients who underwent EUS. Overall diagnostic yield was 59 % (874 /1490; 95 %CI 52 % – 66 %). The most common etiologies were biliary (429 /1490; 30 %, 95 %CI 21 % – 41 %) and chronic pancreatitis (271 /1490; 12 %, 95 %CI 8 % – 19 %). In 2 % of patients, neoplasms were detected (45 /1490; 95 %CI 1 % – 4 %). There was no difference in yield between patients with or without recurrent IAP before EUS (risk ratio 0.89, 95 %CI 0.71 – 1.11).

Conclusions EUS is able to identify a potential etiology in the majority of patients with IAP, detecting mostly biliary origin or chronic pancreatitis, but also neoplasms in 2 % of patients. EUS may be associated with a reduction of recurrence rate. Future studies should include complete diagnostic work-up and preferably include patients with a first episode of IAP only.

Supplementary material



Publication History

Received: 03 December 2019

Accepted: 22 April 2020

Article published online:
17 June 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Refers to:

Author commentary on Devica S. Umans et al.Endoscopy 2020; 52(11): v42-v42
DOI: 10.1055/a-1169-8697

 

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