Endoscopic ultrasonography in pancreatitis

Abstract

Endoscopic ultrasonography (EUS) is a useful imaging modality in the investigation of pancreatitis which provides a high-resolution image of the pancreas and adjacent structures. In patients with ‘idiopathic’ pancreatitis diagnosed by conventional radiologic methods, EUS may help to identify the aetiology by detecting occult pancreatic neoplasm, biliary sludge and microlithiasis. In patients with biliary pancreatitis, EUS was found to be highly sensitive in detecting choledocholithiasis. Therefore, EUS can be used to select patients with choledocholithiasis for therapeutic endoscopic retrograde cholangiopancreatography (ERCP), thus avoiding unnecessary diagnostic endoscopic intervention and the morbidity associated with ERCP in more than onehalf of patients. In addition, EUS can reliably distinguish oedematous from necrotizing acute pancreatitis, and an EUS score appears to have prognostic significance in patients with acute pancreatitis. Clinical studies also suggest that EUS is at least as sensitive as ERCP for diagnosis of chronic pancreatitis, without the risk of causing or worsening pancreatitis as in ERCP. An EUS-guided, fine-needle aspiration may be useful in differentiating pancreatic pseudocysts from neoplastic cystic lesions of the pancreas. Also, EUS-guided or assisted endoscopic drainage of a pseudocyst resulting from pancreatitis is an accepted alternative to surgery in selected patients.