Idiopathic Acute Pancreatitis (IAP): The Value of Endoscopic Ultrasound

Introduction: Acute pancreatitis with unknown etiology comprises about 10-30% of all cases of acute pancreatitis. Endoscopic ultrasound is an important tool for revealing etiologies of the unknown causes of acute pancreatitis. The aim of this study was to evaluate the role of endoscopic ultrasound in sorting out the cause of idiopathic acute pancreatitis. Materials & Methods: It was a cross-sectional study which was carried out in the department of gastroenterology of Sir Salimullah medical college & Mitford hospital from January 2013 to December 2017. A total of 109 patients suffering from acute idiopathic pancreatitis were enrolled in this study. Underlying etiologies could not be detected after thorough history, physical examinations, blood tests, ultrasonography, CT, and/or MRI. These patients underwent endoscopic ultrasound under proper sedation after taking informed consent. Results: Among the 109 patients, 67 were male and 42 were female (P=0.03). Number of patients below 40yrs of age were 67 and above 40 years of age were 42 (P=0.01). Moreover, 81 patients had their gall bladder in situ and 28 had previous history of cholecystectomy (P=0.001). Microlithiasis 20 (24.6%), common bile duct stone or sludge 20 (24.6%), ampullary neoplasm 20 (24.67%), early stage of chronic pancreatitis 12 (14.8%), biliary ascariasis 08 (9.8%), small pancreatic head tumor 02 (2.5%) and pancreatic divisum 02 (2.5%) were found out as the underlying etiologies of idiopathic acute pancreatitis patients who had intact gall bladder. In patients who underwent cholecystectomy; endoscopic ultrasound revealed chronic pancreatitis 04 (14.3%), common bile duct stone or sludge 20 (24.6%), biliary ascariasis 06 (21.4%) and ampullary neoplasm 01 (3.5%) as the hidden causes of idiopathic acute pancreatitis. Conclusion: Gastroenterologists face difficulties to diagnose the actual etiology of idiopathic acute pancreatitis. As endoscopic ultrasound shows high efficacy and accuracy to detect etiologies in such cases; it can be included as a first line investigation in idiopathic acute pancreatitis.