Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut 25001, India.
Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affliate of The Mount Sinai Hospital, Brooklyn, NY 11201, United States.
World J Gastroenterol. 2017 Oct 14;23(38):6952-6961. doi: 10.3748/wjg.v23.i38.6952.
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.
复发性急性胰腺炎（RAP）定义为两次或两次以上急性胰腺炎发作。在 10%-30%的患者中，初始评估未能发现 RAP 的病因，其病情被归类为特发性 RAP（IRAP）。特发性急性胰腺炎（IAP）是消化内科医生面临的诊断挑战。鉴于相关的发病率和死亡率，确定胰腺炎的病因以提供早期治疗和预防复发非常重要。内镜超声（EUS）是胰腺和胆道成像的首选检查方法。鉴于 EUS 的高诊断准确性和安全性，基于 EUS 的管理策略似乎是评估单发/复发性特发性胰腺炎患者的合理方法。在 IAP 中，EUS 最常见的诊断是胆道疾病。本综述旨在讨论 EUS 在 IAP 患者的临床管理和诊断中的作用。它阐述了与 EUS 和其他不同方式相关的 IAP 的诊断方法。详细讨论了 IAP 中的争议问题，例如何时进行 EUS、是在首次发作还是复发性发作后进行、不同检查之间的比较以及最新的证据意义。
