Rôle diagnostique de l’écho-endoscopie dans la pancréatite aiguë

Abstract

In approximately 20% of patients with acute pancreatitis, a cause is not established by history, physical examination, routine laboratory testing or abdominal imaging. Recent studies suggest that microlithiasis is causative in up to 60% of patients with an unexplained acute pancreatitis (UAP) and gallbladder in situ. In the others, many factors play an etiological role in idiopathic pancreatitis, including pancreatic tumors, early chronic pancreatitis, pancreas divisum or annular pancreas, choledochocele, intraductal papillary mucinous tumours (IPMT), an anomalous pancreatobiliary junction or sphincter of Oddi dysfunction (SOD). The close proximity of the endoscopic ultrasound probe (EUS) to the pancreas and biliary tract results in superior spatial resolution compared with CT scan and MRI.The diagnostic yield of EUS in unexplained acute pancreatitis is 80%. EUS appears to be diagnostic in the majority of patients with previously unexplained pancreatitis and offers an alternative to MRI and endoscopic retrograde cholangiopancreatography (ERCP) as the initial diagnostic test in patients with unexplained acute pancreatitis.