Place of Echo Endoscopy in Unexplained Acute Pancreatitis: A Retrospective Study

A. Benhamdane *

Department of Gastroenterology II, HMIMV- Rabat, Morocco.

I. El Koti

Department of Gastroenterology II, HMIMV- Rabat, Morocco.

S. Mrabti

Department of Gastroenterology II, HMIMV- Rabat, Morocco.

T. Addajou

Department of Gastroenterology II, HMIMV- Rabat, Morocco.

R. Berraida

Department of Gastroenterology II, HMIMV- Rabat, Morocco.

F. Rouibaa

Department of Gastroenterology II, HMIMV- Rabat, Morocco.

H. Seddik

Department of Gastroenterology II, HMIMV- Rabat, Morocco.

*Author to whom correspondence should be addressed.


Introduction: Acute pancreatitis may escape etiological diagnosis after clinical, biological and morphological investigation in 10-30% of patients. Echo-endoscopy is promising and particularly effective in exploring the bilio-pancreatic region.

The aim of our study is to evaluate the contribution of echo-endoscopy in unexplained acute pancreatitis.

Materials and Methods: This is a retrospective descriptive study, including 89 patients who underwent echoendoscopy for unexplained acute pancreatitis between January 2008 and December 2022.

Results: The mean age of our patients was 55 ± 16.3 years, with extremes ranging from 17 to 89 years. The sex ratio (M/F) was 0.81, with a slight female predominance of 55.1%.

A history of previous acute pancreatitis was found in 31.9% of cases, and 16.3% of patients had undergone cholecystectomy.

The diagnostic yield in our study was 68% of patients. Biliary origin was retained in 40.4% (n=36) of patients; 19 of whom benefited́ from complementary ERCP at the same anesthetic time. A tumor pathology was found in 32.5% of cases (n=30) and chronic pancreatitis in 22.4% of patients (n=20). We also found two cases of pancreas divisum, one case of sphincter of Oddi dysfunction and one case of choledochocele.

Echo-endoscopy was normal in the remaining 32% of cases, with no cause found.

Conclusion: Echo-endoscopy is currently an indispensable tool in the etiological investigation of unexplained acute pancreatitis. In our study, the diagnostic yield was 68%.

Keywords: Echo endoscopy, unexplained pancreatitis, bilio-pancreatic, idiopathic pancreatitis

How to Cite

Benhamdane , A., I. El Koti, S. Mrabti, T. Addajou, R. Berraida, F. Rouibaa, and H. Seddik. 2024. “Place of Echo Endoscopy in Unexplained Acute Pancreatitis: A Retrospective Study”. Asian Journal of Research and Reports in Gastroenterology 7 (1):22-29.


Download data is not yet available.


Steinberg W, Tenner S. Acute Pancreatitis. N Engl J Med. 1994; 330:1198-1210. DOI: 10.1056/NEJM199404283301706N

Bank S, Indaram A. Causes of acute and recurrent pancreatitis. Gastroenterol Clin North Am. sept 1999;28(3):571‑89. DOI: 10.1016/S0889-8553(05)70074-1

Frossard JL, Sosa¬Valencia L, Amouyal G, et al. Usefulness of endoscopic ultrasonography in patients with “idiopathic” acute pancreatitis. Am J Med. 2000; 109:196¬200. PMID: 10974181 DOI: 10.1016/S0002¬9343(00)00478¬2

Rana SS, Bhasin DK, Rao C, et al. Role of endoscopic ultrasound in idiopathic acute pancreatitis with negative ultrasound, computed tomography, and magnetic resonance cholangiopancreatography. Ann Gastroenterol. 2012; 25:133¬137 [PMID: 24714266]

Wilcox CM, Seay T, Kim H, et al. Prospective endoscopic ultrasound-based approach to the evaluation of idiopathic pancreatitis: Causes, response to therapy, and long¬ term outcome. Am J Gastroenterol. 2016; 111:1339¬1348. PMID: 27325219. DOI: 10.1038/ajg.2016.240

Smith I, Ramesh J, Kabir Baig KR, et al. Emerging role of endoscopic ultrasound in the diagnostic evaluation of idiopathic pancreatitis. Am J Med Sci. 2015;350:229-234. PMID: 26252794. DOI: 10.1097/ MAJ.000000000000054.

Liu CL, Lo CM, Chan JK, et al. EUS for detection of occult cholelithiasis in patients with idiopathic pancreatitis. Gastrointest Endosc. 2000;51:28¬32. PMID: 10625791. DOI: 10.1016/S0016¬5107(00)70382¬8

Vila JJ, Vicuña M, Irisarri R, et al. Diagnostic yield and reliability of endoscopic ultrasonography in patients with idiopathic acute pancreatitis. Scand J Gastroenterol. 2010;45:375¬381. PMID: 20034361. DOI: 10.3109/00365520903 508894.

Tandon M, Topazian M. Endoscopic ultrasound in idiopathic acute pancreatitis. Am J Gastroenterol. 2001; 96: 705¬709. PMID: 11280538. DOI: 10.1111/j.1572¬0241.2001. 03609.x

Rana SS, Gonen C, Vilmann P. Endoscopic ultrasound and pancreas divisum. JOP. 2012; 13:252¬257. PMID: 22572127.

Sharma M, Pathak A, Rameshbabu CS, et al. Imaging of pancreas divisum by linear-array endoscopic ultrasonography. Endosc Ultrasound. 2016; 5:21¬29. PMID: 26879163. DOI: 10.4103/2303¬9027.175878

DeWitt J, Devereaux B, Chriswell M, et al. Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med. 2004;141:753¬763. PMID: 15545675. DOI: 10.7326/0003¬4819¬141¬10¬200411160-00006

Klapman JB, Chang KJ, Lee JG, et al. Negative predictive value of endoscopic ultrasound in a large series of patients with a clinical suspicion of pancreatic cancer. Am J Gastroenterol. 2005;100:2658¬2661. PMID: 16393216. DOI: 10.1111/ j.1572¬0241.2005.00315.x.

Yusoff IF, Raymond G, Sahai AV. A prospective comparison of the yield of EUS in primary vs. recurrent idiopathic acute pancreatitis. Gastrointest Endosc. 2004;60:673¬678. PMID: 15557941. DOI: 10.1016/S0016¬5107(04)02018¬8

Teshima CW, Sandha GS. Endoscopic ultrasound in the diagnosis and treatment of pancreatic disease. World J Gastroenterol. 2014;20:9976¬9989. PMID: 25110426. DOI: 10.3748/wjg.v20.i29.9976

Pereira R, Eslick G, Cox M, Endoscopic ultrasound for routine assessment in idiopathic acute pancreatitis. Journal of Gastrointestinal Surgery. DOI: 0.1007/s11605-019-04272-3

Norton SA, Alderson D. Endoscopic ultrasonography in the evaluation of idiopathic acute pancreatitis. Br J Surg. 2000;87:1650–5. PMID: 11122178. DOI: 10.1046/j.1365-2168.2000.01587.x

Wilcox CM, Varadarajulu S, Eloubeidi M. Role of endoscopic evaluation in idiopathic pancreatitis: a systematic review. Gastrointest Endosc. 2006;63:1037–45. PMID: 16733122. DOI: 10.1016/j.gie.2006.02.024

Ardengh JC, Malheiros CA, Rahal F, et al. Microlithiasis of the gallbladder: Role of endoscopic ultrasonography in patients with idio- pathic acute pancreatitis. Rev Assoc Med Bras. 2010;56:27–31. PMID: 20339782. DOI: 10.1590/s0104-42302010000100011

Elta GH. Sphincter of Oddi dysfunction and bile duct microlithiasis in acute idiopathic pancreatitis. World J Gastroenterol. 2008;14:1023–6. PMID: 18286682. DOI: 10.3748/wjg.14.1023

Catalano MF, Geenen JE. Diagnosis of chronic pancreatitis by endoscopic ultrasonography. endoscopy. Août. 1998;30(S 1):A 111-A 115. PMID: 9765100. DOI: 10.1055/s-2007-1001489

Wiersema MJ. Endosonography-guided cystoduodenostomy with a therapeutic ultrasound endoscope. Gastrointest Endosc. 1996;44(5):614‑7. PMID: 8934175. DOI: 10.1016/s0016-5107(96)70022-6

Mujica VR, Barkin JS, Go VLW, Participants SG. Acute pancreatitis secondary to pancreatic carcinoma. Pancreas. 2000;21(4):329‑32. PMID: 11075985. DOI: 10.1097/00006676-200011000-00001

Guzzardo G, Kleinman MS, Krackov JH, et al. Recurrent acute pancreatitis caused by Ampullary Villous Adenoma. J Clin Gastroenterol. avr 1990;12(2):200‑2. PMID: 2182707. DOI: 10.1097/00004836-199004000-00020

DeFrain C, Chang CY, Srikureja W, et al. Cytologic features and diagnostic pitfalls of primary ampullary tumors by endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer. 2005;105(5):289‑97. PMID: 15986397. DOI: 10.1002/cncr.21306

Sahel J, Cros RC, Bourry J, et al. Clinico-Pathological conditions associated with pancreas divisum. Digestion. 1982;23(1):1‑8. PMID: 7084565. DOI: 10.1159/000198689

Kushnir VM, Wani SB, Fowler K, et al. Sensitivity of endoscopic ultrasound, multidetector computed tomography, and magnetic resonance cholangiopancreatography in the diagnosis of pancreas divisum: a tertiary center experience. Pancreas. 2013;42:436-441. PMID: 23211370 DOI: 10.1097/MPA.0b013e31826c711a

Working Party of the British Society of G, Association of Surgeons of Great B, Ireland, Pancreatic Society of Great B, Ireland, Association of Upper GISoGB, et al. UK guidelines for the management of acute pancreatitis. Gut. 2005;54 Suppl 3:iii1-9. PMID: 15831893. DOI: 10.1136/gut.2004.057026

Lee SP, Nicholls JF, Park HZ. Biliary sludge as a cause of acute pancreatitis. N Engl J Med. 1992;326(9):589‑93. PMID: 1734248. DOI: 10.1056/NEJM199202273260902

Working Group IAPAPAAPG. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4 Suppl 2):e1-15. PMID: 24054878. DOI: 10.1016/j.pan.2013.07.063