Prospective assessment of the utility of EUS in the evaluation of gallstone pancreatitis

Background: The ability to identify common bile duct stones by noninvasive means in patients with acute biliary pancreatitis is limited. The aim of th is study was to prospectively evaluate the ability of endosonography (EUS) to identify cholelithiasis and choledocholithiasis and predict disease seve rity in patients with nonalcoholic pancreatitis. Methods: EUS was performed immediately before endoscopic retrograde cholang iopancreatography (ERCP) by separate blinded examiners within 72 hours of a dmission. Gallbladder findings were compared between EUS and transabdominal ultrasonography (US). Using endoscopic extraction of a bile duct stone as the reference standard for choledocholithiasis, the diagnostic yield of EUS was compared with transabdominal US and ERCP. Features identified during e ndosonographic imaging of the pancreas were correlated with length of hospi talization. Results: Thirty-six patients were studied. EUS and transabdominal US were c oncordant in their interpretation of gallbladder findings in 92% of patient s. The sensitivity of transabdominal US, EUS, and ERCP for identifying chol edocholithiasis was 50%, 91%, and 92% and the accuracy was 83%, 97%, and 89 %, respectively. Length of hospital stay was longer in patients with peripa ncreatic fluid (9.2 vs. 5.7 days, p < 0.1) and shorter in patients with coa rse echo texture (2.6 vs. 7.2 days, p < 0.05) demonstrated on EUS. Conclusions: EUS can reliably identify cholelithiasis and is more sensitive than transabdominal US in detecting choledocholithiasis in patients with b iliary pancreatitis. EUS may be used early in the management of patients wi th acute pancreatitis to select those who would benefit from endoscopic sto ne extraction. The utility of EUS for predicting pancreatitis severity requ ires further investigation.