Idiopathic acute pancreatitis: Advancing diagnostics and preventing recurrence

Research output: PhD ThesisPhd-Thesis - Research and graduation internal


The central aim of this thesis, comprising of eight studies in four parts, was to identify methods why which the management of patients with presumed idiopathic acute pancreatitis could be enhanced, to prevent pancreatitis recurrence and improve outcomes for patients.
In the first part, existing paradigms in idiopathic acute pancreatitis were examined. It was found that recurrence is relatively high in patients with idiopathic acute pancreatitis Thus, we should strive for the optimal diagnostic strategy.
In the second part, diagnostic strategies for aetiology in acute pancreatitis were explored. We found that in patients with a gallbladder in situ, elevation of more than four, three and two times the upper limit of normal of gamma-glutamyltransferase, total bilirubin and aspartate transferase, respectively, should be considered a proxy for biliary aetiology. Repetition of transabdominal ultrasonography after resolution of acute pancreatitis and if negative, endoscopic ultrasonography should be performed to detect aetiology in all patients with a first episode of idiopathic acute pancreatitis.
In the third part, feasibility of pragmatic treatment of presumed underlying aetiologies was investigated. In a systematic review, cholecystectomy appeared to lower the risk of pancreatitis recurrence in patients with idiopathic acute pancreatitis.
Finally, in the fourth part, a reflection on the outcomes of the studies was provided along with recommendations for future research. Most notably, we need a randomized controlled trial to determine whether cholecystectomy could prevent recurrence in patients with idiopathic acute pancreatitis after negative endoscopic ultrasonography. This trial is executed at the time of publication of this thesis.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • University of Amsterdam
  • van Hooft, Jeanin, Supervisor
  • Besselink, Marc, Supervisor
  • Fockens, Paul, Co-supervisor
  • Verdonk, Robert C., Co-supervisor, External person
Award date27 Jan 2023
Print ISBNs9789464691320
Publication statusPublished - 2023

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