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Radial EUS Examination Can be Helpful in Predicting the Severity of Acute Biliary Pancreatitis

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ABSTRACT

We investigated the utility of noncontrast enhanced endosonography (EUS) in predicting the severity of acute pancreatitis (AP) during the first 72 to 96 h of admission.

In total, 187 patients with acute biliary pancreatitis were included. The patients were classified into 2 groups as having severe and mild AP according to the Modified Glasgow scoring and computerized tomography severity index (SI). The 158 cases with mild and 29 cases with severe AP had a similar age and sex distribution.

Although none of the cases with mild AP developed morbidity and death, of the cases with severe AP, 16 developed serious morbidities and 5 died. On EUS examination, we looked for parenchymal findings, peripancreatic inflammatory signs, free or loculated fluid collections, and abnormalities of the common bile duct and the pancreatic channel. Statistical analysis indicated a significant relationship between the severity of AP with diffuse parenchymal edema, periparenchymal plastering, and/or diffuse retroperitoneal free fluid accumulation, and peri-pancreatic edema. We also defined an EUSSI and found that the EUSSI had sensitivity of 89.7%, specificity of 84.2%, positive predictivity value (PPV) of 88.9%, negative predictivity value (NPV) of 91.2%, and an accuracy of 87.9% in the differentiation of mild and severe AP. We found that the EUSSI had an accuracy of 72.4%, sensitivity of 75.4%, specificity of 65.1%, PPV of 69.3%, and NPV of 73.1% for determining mortality.

Our data suggest that EUS allowed us to accurately predict the severity and mortality in nearly 90% of cases with AP.

No MeSH data available.


Related in: MedlinePlus

Diffuse parenchymal edema, diffuse enlargement, and plastering fluid collection are seen.
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Figure 2: Diffuse parenchymal edema, diffuse enlargement, and plastering fluid collection are seen.

Mentions: Twenty-one patients in the SAP group had pancreatic necrosis on dynamic CT imaging. In these patients, 9 of them had necrosis in >30% of the parenchyma and the others had necrosis ≤2 cm in size. In 18 of these cases, EUS demonstrated relatively hypo or anechoic appearances with irregular contours within the pancreas. In all of them, the extent and distribution of this EUS appearance in the pancreas was completely similar to the extent and distribution of the necrotic field demonstrated on dynamic CT imaging (Figures 1 and 2). However, 2 patients who had irregular pancreatic parenchyma with hypo-anechoic regions in the pancreas head and corpus did not have abnormal appearances on dynamic CT examination. When we accept dynamic CT as the gold standard for detecting pancreatic necrosis, the accuracy, sensitivity, specificity, and PPV and NPV of EUS examination for necrosis were highly striking as 92%, 85%, 94%, 79%, and 96%, respectively.


Radial EUS Examination Can be Helpful in Predicting the Severity of Acute Biliary Pancreatitis
Diffuse parenchymal edema, diffuse enlargement, and plastering fluid collection are seen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998239&req=5

Figure 2: Diffuse parenchymal edema, diffuse enlargement, and plastering fluid collection are seen.
Mentions: Twenty-one patients in the SAP group had pancreatic necrosis on dynamic CT imaging. In these patients, 9 of them had necrosis in >30% of the parenchyma and the others had necrosis ≤2 cm in size. In 18 of these cases, EUS demonstrated relatively hypo or anechoic appearances with irregular contours within the pancreas. In all of them, the extent and distribution of this EUS appearance in the pancreas was completely similar to the extent and distribution of the necrotic field demonstrated on dynamic CT imaging (Figures 1 and 2). However, 2 patients who had irregular pancreatic parenchyma with hypo-anechoic regions in the pancreas head and corpus did not have abnormal appearances on dynamic CT examination. When we accept dynamic CT as the gold standard for detecting pancreatic necrosis, the accuracy, sensitivity, specificity, and PPV and NPV of EUS examination for necrosis were highly striking as 92%, 85%, 94%, 79%, and 96%, respectively.

View Article: PubMed Central - PubMed

ABSTRACT

We investigated the utility of noncontrast enhanced endosonography (EUS) in predicting the severity of acute pancreatitis (AP) during the first 72 to 96 h of admission.

In total, 187 patients with acute biliary pancreatitis were included. The patients were classified into 2 groups as having severe and mild AP according to the Modified Glasgow scoring and computerized tomography severity index (SI). The 158 cases with mild and 29 cases with severe AP had a similar age and sex distribution.

Although none of the cases with mild AP developed morbidity and death, of the cases with severe AP, 16 developed serious morbidities and 5 died. On EUS examination, we looked for parenchymal findings, peripancreatic inflammatory signs, free or loculated fluid collections, and abnormalities of the common bile duct and the pancreatic channel. Statistical analysis indicated a significant relationship between the severity of AP with diffuse parenchymal edema, periparenchymal plastering, and/or diffuse retroperitoneal free fluid accumulation, and peri-pancreatic edema. We also defined an EUSSI and found that the EUSSI had sensitivity of 89.7%, specificity of 84.2%, positive predictivity value (PPV) of 88.9%, negative predictivity value (NPV) of 91.2%, and an accuracy of 87.9% in the differentiation of mild and severe AP. We found that the EUSSI had an accuracy of 72.4%, sensitivity of 75.4%, specificity of 65.1%, PPV of 69.3%, and NPV of 73.1% for determining mortality.

Our data suggest that EUS allowed us to accurately predict the severity and mortality in nearly 90% of cases with AP.

No MeSH data available.


Related in: MedlinePlus