Original Article
John J. Kim, Nicole Shah-Ghass
Abstract
Background The diagnostic yield of performing endoscopic ultrasound in hospitalized patients with acute pancreatitis is controversial. Aims To evaluate and compare the diagnostic yield, safety, and completeness of performing endoscopic ultrasound during or after hospitalization following acute pancreatitis. Methods Consecutive patients who underwent endoscopic ultrasound following an episode of acute pancreatitis (2007-20014) were searched from an internal endoscopy database. Endoscopic ultrasound findings and clinical course were reviewed. Telephone interview was conducted to verify the final etiology of acute pancreatitis. Results Of 61 patients (mean age=50 ± 19 years), 29 (48%) had focal pancreatic lesions identified on cross-sectional imaging. Mean days to EUS from presentation was reduced in 29 (47%) patients receiving endoscopic ultrasound during (9.0 ± 7.9 vs. 69.6 ± 75.5; mean difference=60.6 days, 95%CI 33.0-89.4) compared to 32 (53%) after hospitalization. Among patients receiving EUS during hospitalization, fine-needle aspiration was performed in 14 (50%) and a new cause was identified in 4 (14%) (Pancreatic adenocarcinoma in 3, choledocholithiasis in 1). No difference in diagnostic yield, proportion of incomplete procedure, or adverse events was observed among the groups receiving endoscopic ultrasound during or after hospitalization. During follow-up (4.6 ± 3.5 years), one patient was later diagnosed with pancreatic adenocarcinoma after receiving an incomplete endoscopic ultrasound during hospitalization. Conclusions In patients receiving endoscopic ultrasound following acute pancreatitis, nearly half had focal pancreatic lesions detected on cross-sectional imaging and tenth were diagnosed with pancreatic neoplasms. Endoscopic ultrasound performed during hospitalization led to a more rapid diagnosis, without difference in diagnostic yield or adverse events, compared to endoscopic ultrasound performed after hospitalization.