Early EUS in Acute Biliary Pancreatitis
Early EUS in Acute Biliary Pancreatitis
Acute biliary pancreatitis (ABP) is a potentially life-threatening condition caused by common
 bile duct (CBD) stones or sludge, which requires prompt diagnosis and treatment by endoscopic
 removal of the material. Accurate detection of CBD stones is warranted to select patients for
 early therapeutic endoscopic retrograde cholangiopancreatography (ERCP).

 In clinical practice the decision to perform an ERCP is often based on biochemical and
 radiological criteria despite they already have been shown to be unreliable predictors of CBD
 stone presence.

 Endoscopic ultrasound (EUS) is not currently a worldwide standard diagnostic procedure early
 in the course of acute biliary pancreatitis, but it has been shown to be accurate, safe and
 cost effective in diagnosing biliary obstructions compared with magnetic resonance
 cholangiopancreatography (MRCP) and ERCP and therefore in preventing unnecessary ERCP and its
 related complications.

 The investigators aim to investigate the clinical usefulness of early EUS in the management
 of ABP.

 All consecutive patients entering the emergency department due to acute abdominal pain and
 showing biochemical and/or radiological findings consistent with possible ABP will be
 prospectively enrolled. Patients will be classified as having a low, moderate, or high
 probability of CBD stones, according to established risk stratification. All enrolled
 patients will undergo EUS within 48 h of their admission. ERCP will be performed immediately
 after EUS only in those cases with proven CBD stones or sludge.

 The following parameters will be investigated: (1) clinical: age, sex, fever; (2)
 radiological: dilated CBD, (3) biochemical: bilirubin, aspartate aminotransferase (AST),
 alanine aminotransferase (ALT), gamma glutamyl transferase (gGT), alkaline phosphatase (ALP),
 amylase, lipases, C-reactive protein (CRP). Association between presence of CBD stone at EUS
 and the individual predictors were assessed by univariate logistic regression. Predictors
 significantly associated with CBD stones (p<0.05) will enter in a multivariate logistic
 regression model.
Inclusion Criteria:

 -  All consecutive patients entering the emergency department for possible acute biliary
 pancreatitis

 Exclusion Criteria:

 -  gastrectomy

 -  patient in whom the cause of biliary obstruction was already identified by US