TY - JOUR
T1 - Prospective multicentre study of indications for surgery in patients with idiopathic acute pancreatitis following endoscopic ultrasonography (PICUS)
AU - Umans, Devica S.
AU - Timmerhuis, Hester C.
AU - Anten, Marie-Paule G. F.
AU - Bhalla, Abha
AU - Bijlsma, Rina A.
AU - Boxhoorn, Lotte
AU - Brink, Menno A.
AU - Bruno, Marco J.
AU - Curvers, Wouter L.
AU - van Eijck, Brechje C.
AU - Erkelens, G. Willemien
AU - van Geenen, Erwin J. M.
AU - Hazen, Wouter L.
AU - Hoge, Chantal V.
AU - Hol, Lieke
AU - Inderson, Akin
AU - Kager, Liesbeth M.
AU - Kuiken, Sjoerd D.
AU - Perk, Lars E.
AU - Quispel, Rutger
AU - Römkens, Tessa E. H.
AU - Sperna Weiland, Christina J.
AU - Thijssen, Annemieke Y.
AU - Venneman, Niels G.
AU - Verdonk, Robert C.
AU - van Wanrooij, Roy L. J.
AU - Witteman, Ben J.
AU - Besselink, Marc G.
AU - van Hooft, Jeanin E.
N1 - Funding Information: This investigator-initiated study was supported by the Dutch Digestive Disease Foundation (Maag Lever Darm Stichting, grant number D17-25). The sponsor was not involved in the study design, in the collection, analysis or interpretation of the data, or in the writing of the report. Acknowledgements Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - BACKGROUND: Cholecystectomy in patients with idiopathic acute pancreatitis (IAP) is controversial. A randomized trial found cholecystectomy to reduce the recurrence rate of IAP but did not include preoperative endoscopic ultrasonography (EUS). As EUS is effective in detecting gallstone disease, cholecystectomy may be indicated only in patients with gallstone disease. This study aimed to determine the diagnostic value of EUS in patients with IAP, and the rate of recurrent pancreatitis in patients in whom EUS could not determine the aetiology (EUS-negative IAP). METHODS: This prospective multicentre cohort study included patients with a first episode of IAP who underwent outpatient EUS. The primary outcome was detection of aetiology by EUS. Secondary outcomes included adverse events after EUS, recurrence of pancreatitis, and quality of life during 1-year follow-up. RESULTS: After screening 957 consecutive patients with acute pancreatitis from 24 centres, 105 patients with IAP were included and underwent EUS. In 34 patients (32 per cent), EUS detected an aetiology: (micro)lithiasis and biliary sludge (23.8 per cent), chronic pancreatitis (6.7 per cent), and neoplasms (2.9 per cent); 2 of the latter patients underwent pancreatoduodenectomy. During 1-year follow-up, the pancreatitis recurrence rate was 17 per cent (12 of 71) among patients with EUS-negative IAP versus 6 per cent (2 of 34) among those with positive EUS. Recurrent pancreatitis was associated with poorer quality of life. CONCLUSION: EUS detected an aetiology in a one-third of patients with a first episode of IAP, requiring mostly cholecystectomy or pancreatoduodenectomy. The role of cholecystectomy in patients with EUS-negative IAP remains uncertain and warrants further study.
AB - BACKGROUND: Cholecystectomy in patients with idiopathic acute pancreatitis (IAP) is controversial. A randomized trial found cholecystectomy to reduce the recurrence rate of IAP but did not include preoperative endoscopic ultrasonography (EUS). As EUS is effective in detecting gallstone disease, cholecystectomy may be indicated only in patients with gallstone disease. This study aimed to determine the diagnostic value of EUS in patients with IAP, and the rate of recurrent pancreatitis in patients in whom EUS could not determine the aetiology (EUS-negative IAP). METHODS: This prospective multicentre cohort study included patients with a first episode of IAP who underwent outpatient EUS. The primary outcome was detection of aetiology by EUS. Secondary outcomes included adverse events after EUS, recurrence of pancreatitis, and quality of life during 1-year follow-up. RESULTS: After screening 957 consecutive patients with acute pancreatitis from 24 centres, 105 patients with IAP were included and underwent EUS. In 34 patients (32 per cent), EUS detected an aetiology: (micro)lithiasis and biliary sludge (23.8 per cent), chronic pancreatitis (6.7 per cent), and neoplasms (2.9 per cent); 2 of the latter patients underwent pancreatoduodenectomy. During 1-year follow-up, the pancreatitis recurrence rate was 17 per cent (12 of 71) among patients with EUS-negative IAP versus 6 per cent (2 of 34) among those with positive EUS. Recurrent pancreatitis was associated with poorer quality of life. CONCLUSION: EUS detected an aetiology in a one-third of patients with a first episode of IAP, requiring mostly cholecystectomy or pancreatoduodenectomy. The role of cholecystectomy in patients with EUS-negative IAP remains uncertain and warrants further study.
UR - http://www.scopus.com/inward/record.url?scp=85176508513&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/bjs/znad318
DO - https://doi.org/10.1093/bjs/znad318
M3 - Article
C2 - 37811814
SN - 0007-1323
VL - 110
SP - 1877
EP - 1882
JO - The British journal of surgery
JF - The British journal of surgery
IS - 12
ER -