Open AccessThe diagnostic work‐up and outcomes of ‘presumed’ idiopathic acute pancreatitis: A post‐hoc analysis of a multicentre observational cohort
Author(s) -
Hallensleben Nora D,
Umans Devica S,
Bouwense Stefan AW,
Verdonk Robert C,
Romkens Tessa EH,
Witteman Ben J,
Schwartz Matthijs P,
Spanier Marcel B,
Laheij Robert,
Santvoort Hjalmar C,
Besselink Marc G,
Hooft Jeanin E,
Bruno Marco J
Publication year - 2020
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640619890462
Subject(s) - medicine , etiology , acute pancreatitis , pancreatitis , work up , gastroenterology , cohort
After standard diagnostic work‐up, the aetiology of acute pancreatitis remains unknown in 16–27% of cases, a condition referred to as idiopathic acute pancreatitis (IAP). Determining the aetiology of pancreatitis is essential, as it may direct treatment in the acute phase and guides interventions to prevent recurrent pancreatitis. Methods Between 2008 and 2015, patients with acute pancreatitis were registered prospectively in 19 Dutch hospitals. Patients who had a negative initial diagnostic work‐up with regard to the underlying aetiology of their pancreatitis were labelled ‘presumed’ IAP. The aim of this study was to assess the use of diagnostic modalities and their yield to establish an aetiology in ‘presumed’ IAP, and to assess recurrence rates both with and without treatment. Results Out of the 1632 registered patients, 191 patients had a first episode of ‘presumed’ IAP, of whom 176 (92%) underwent additional diagnostic testing: CT ( n = 124, diagnostic yield 8%), EUS ( n = 62, yield 35%), MRI/MRCP ( n = 56, yield 33%), repeat ultrasound ( n = 97, yield 21%), IgG4 (n = 54, yield 9%) and ERCP ( n = 15, yield 47%). In 64 of 176 patients (36%) an aetiological diagnosis was established, mostly biliary ( n = 39). In 13 out of 176 of patients (7%) a neoplasm was diagnosed. If additional diagnostic workup revealed an aetiology, the recurrence rate was lower in the treated patients than in the patients without a definite aetiology (15% versus 43%, p = 0.014). Conclusion Additional diagnostic testing revealed an aetiology in one‐third of ‘presumed’ IAP patients. The aetiology found was mostly biliary, but occasionally neoplasms were found. Identification of an aetiology with subsequent treatment reduced the rate of recurrence.