Department of Gastroenterology, CHU Toulouse, University of Toulouse III, Toulouse, France.
Dig Dis Sci. 2013 Aug;58(8):2361-8. doi: 10.1007/s10620-013-2632-y. Epub 2013 Mar 19.
The efficacy of endoscopic ultrasonography (EUS) to diagnose idiopathic acute pancreatitis has been demonstrated but that of magnetic-resonance cholangiopancreatography (MRCP) remains unclear.
The aim of our study was to prospectively compare the results of EUS and MRCP to diagnose idiopathic acute pancreatitis when performed later after an acute attack.
All patients admitted to our center for acute pancreatitis over a 2-year period received first-line investigations that included medical history, standard biological measurements, abdominal ultrasound, and computerized tomography. If no etiology was found, second-line investigations were scheduled at 2 months (or more if there was severe pancreatitis), which included clinical examinations, biological parameters, EUS, and MRCP.
A total of 128 consecutive patients were included (male: 80, mean age: 55.3 years). After first-line investigations, 41 patients with idiopathic acute pancreatitis underwent second-line investigations and were followed-up (38 patients had both EUS and MRCP). EUS and/or MRCP led to recognize a possible etiology of pancreatitis in 19 patients (50 %). The diagnostic yield for EUS was higher than for MRCP (29 vs. 10.5 %). EUS more accurately detected biliary stones whereas MRCP identified pancreatic duct abnormalities, such as intraductal papillary mucinous neoplasm of the pancreas or chronic pancreatitis.
The combination of EUS and MRCP, when performed later after idiopathic acute pancreatitis, revealed 50 % of etiologies. The association of these two procedures and the subsequent follow-up reduced the rate of idiopathic pancreatitis by ~66 %.
内镜超声检查（EUS）诊断特发性急性胰腺炎的疗效已得到证实，但磁共振胰胆管成像（MRCP）的疗效尚不清楚。
我们的研究旨在前瞻性比较 EUS 和 MRCP 在急性发作后较晚时间诊断特发性急性胰腺炎的结果。
在为期 2 年的时间里，我们中心所有因急性胰腺炎入院的患者均接受了一线检查，包括病史、标准生物学测量、腹部超声和计算机断层扫描。如果未发现病因，则在 2 个月后（如果胰腺炎严重则更长时间）安排二线检查，包括临床检查、生物学参数、EUS 和 MRCP。
共纳入 128 例连续患者（男性 80 例，平均年龄 55.3 岁）。在一线检查后，41 例特发性急性胰腺炎患者接受了二线检查并进行了随访（38 例患者同时进行了 EUS 和 MRCP）。EUS 和/或 MRCP 发现 19 例（50%）可能的胰腺炎病因。EUS 的诊断率高于 MRCP（29%比 10.5%）。EUS 更准确地检测到胆管结石，而 MRCP 则识别出胰腺导管异常，如胰腺内导管乳头状黏液瘤或慢性胰腺炎。
特发性急性胰腺炎发作后较晚时间进行的 EUS 和 MRCP 联合检查揭示了 50%的病因。这两种方法的联合应用以及随后的随访将特发性胰腺炎的发生率降低了约 66%。
