Original articleComparison of Early Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in the Management of Acute Biliary Pancreatitis: A Prospective Randomized Study
Section snippets
Methods
We performed a single-centered, open-labeled, prospective randomized controlled study to test the hypothesis that the management of patients with acute biliary pancreatitis could be improved by an early EUS examination. During a 30-month study period from July 2001–December 2003, 207 patients with the diagnosis of acute pancreatitis were managed at the Department of Surgery, Queen Mary Hospital, Hong Kong. One hundred forty patients with the first episode of acute pancreatitis, which was
Results
Among the 140 patients presenting with the first episode of acute pancreatitis with a suspected biliary cause included in the study, there were 62 men and 78 women with a median age of 69 years. Thirteen patients (9%) were clinically jaundiced, and 20 (14%) of them were febrile on admission. Sixty-eight patients (49%) were found to have a severe attack of acute pancreatitis with a Ranson’s score11 of 3 or more. Clinical parameters of both the EUS group and the ERCP group are listed in Table 1
Discussion
Although ERCP has been considered the gold standard for imaging the bile duct in patients with suspected biliary pancreatitis, and early ERCP with ES when choledocholithiasis is detected has been reported to reduce the morbidity rates,2, 3 this approach is characterized by a high number of unnecessary ERCPs. The complication rate associated with ERCP is significant with a nontrivial mortality rate.4 Large prospective case series have shown that the overall complication rates were 5%–6%, and the
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Cited by (117)
Outcomes and timing of endoscopic retrograde cholangiopancreatography for acute biliary pancreatitis
2019, Digestive and Liver DiseaseEndoscopic Ultrasound and Fine-Needle Aspiration for Pancreatic and Biliary Disorders
2019, Clinical Gastrointestinal EndoscopyDiagnostic accuracy of EUS compared with MRCP in detecting choledocholithiasis: a meta-analysis of diagnostic test accuracy in head-to-head studies
2017, Gastrointestinal EndoscopyCitation Excerpt :These studies showed an excellent negative predictive value for EUS before ERCP, likely because of higher sensitivity consistent with our findings. The results of our study could hence emphasize more targeted ERCP procedures, given higher sensitivity and the fact that both EUS and ERCP could be done in the same session.28-30 The results of our meta-analysis should be interpreted with caution, given the limitations in conducting a meta-analysis.
Chapter 56 - Management of acute pancreatitis and complications
2017, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth EditionEndoscopic ultrasound and endoscopic retrograde cholangiopancreatography: Can they be successfully combined?
2016, Gastroenterologia y HepatologiaCitation Excerpt :EUS appears comparable to ERCP as a diagnostic test for CBD stones, is superior to other techniques for detecting biliary stones, and can be used to select patients who will need therapeutic ERCP. This results in a significantly lower risk of complications in comparison with the use of ERCP for both diagnosis and treatment of choledocholithiasis.30,36,40,41 By performing EUS first, ERCP may be safely avoided in patients with common bile duct stones.
Supported by the Sun C.Y. Research Foundation for Hepatobiliary and Pancreatic Surgery of the University of Hong Kong.