Abstract
IntroductionIdiopathic acute pancreatitis (IAP) remains a dilemma for physicians as it is uncertain whether patients with IAP may actually have an occult aetiology. It is unclear to what extent additional diagnostic modalities such as endoscopic ultrasonography (EUS) are warranted after a first episode of IAP in order to uncover this aetiology. Failure to timely determine treatable aetiologies delays appropriate treatment and might subsequently cause recurrence of acute pancreatitis. Therefore, the aim of the Pancreatitis of Idiopathic origin: Clinical added value of endoscopic UltraSonography (PICUS) Study is to determine the value of routine EUS in determining the aetiology of pancreatitis in patients with a first episode of IAP.Methods and analysisPICUS is designed as a multicentre prospective cohort study of 106 patients with a first episode of IAP after complete standard diagnostic work-up, in whom a diagnostic EUS will be performed. Standard diagnostic work-up will include a complete personal and family history, laboratory tests including serum alanine aminotransferase, calcium and triglyceride levels and imaging by transabdominal ultrasound, magnetic resonance imaging or magnetic resonance cholangiopancreaticography after clinical recovery from the acute pancreatitis episode. The primary outcome measure is detection of aetiology by EUS. Secondary outcome measures include pancreatitis recurrence rate, severity of recurrent pancreatitis, readmission, additional interventions, complications, length of hospital stay, quality of life, mortality and costs, during a follow-up period of 12 months.Ethics and disseminationPICUS is conducted according to the Declaration of Helsinki and Guideline for Good Clinical Practice. Five medical ethics review committees assessed PICUS (Medical Ethics Review Committee of Academic Medical Center, University Medical Center Utrecht, Radboud University Medical Center, Erasmus Medical Center and Maastricht University Medical Center). The results will be submitted for publication in an international peer-reviewed journal.Trial registration numberNetherlands Trial Registry (NL7066). Prospectively registered.
Highlights
Idiopathic acute pancreatitis (IAP) remains a dilemma for physicians as it is uncertain whether patients with IAP may have an occult aetiology
Previous research has suggested that endoscopic ultrasonography (EUS) might be beneficial in the detection of an aetiology in presumed IAP
Data lack on the efficacy of routine EUS in patients with a first episode of presumed IAP, after repeat imaging after clinical recovery is negative for an aetiology
Summary
Idiopathic acute pancreatitis (IAP) remains a dilemma for physicians as it is uncertain whether patients with IAP may have an occult aetiology. Gallstone disease (approximately 50%) and alcohol (approximately 20%) are the most frequent causes,[1,2,3,4,5,6] the prevalence of aetiologies of acute pancreatitis is dependent on, among other things, age and geographical factors.[7,8,9,10] There is, a considerable group of patients of approximately 25% in whom no aetiology can be found after routine diagnostic work-up (ie, medical history, laboratory investigations and transabdominal ultrasound) These patients are considered to have presumed idiopathic acute pancreatitis (IAP).[3]. Undetected and subsequently untreated gallstone disease poses a risk for recurrent acute pancreatitis and other biliary events, for example, cholecystitis, biliary colic and cholangitis
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