Acute pancreatitis other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and interventional procedure technique using both endoscopy and fluoroscopy for examination and intervention of the biliary tree and pancreatic ducts. Complications of ERCP may include pancreatitis, hemorrhage, cholangitis, and pneumobilia. Contraindications may include unstable patient, coagulopathy and structural abnormalities of esphagus, stomach or duodenum.

Other Imaging Findings

Role of ERCP

According to the American college of gastroenterology, following are the guidelines for the management of acute pancreatitis:[1][2][3][4][5][6]

Recommendation Evidence Level Strength of Recommendation
Patients with acute pancreatitis and concurrent acute cholangitis should undergo ERCP within 24 h of admission Moderate Strong
ERCP is not needed in most patients with gallstone pancreatitis who lack laboratory or clinical evidence of ongoing biliary obstruction Low Strong
In the absence of cholangitis and/or jaundice, MRCP or endoscopic ultrasound (EUS) rather than diagnostic ERCP should be used to screen for choledocholithiasis if highly suspected Low Conditional
Pancreatic duct stents and/or postprocedure rectal nonsteroidal anti-inflammatory drug (NSAID) suppositories should be utilized to prevent severe post-ERCP pancreatitis in high-risk patients  Moderate Conditional
  • Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and interventional procedure technique using both endoscopy and fluoroscopy for examination and intervention of the biliary tree and pancreatic ducts. 
  • ERCP involves passing an endoscope to the descending duodenum and subsequently cannulating the ampulla of Vater, and visualizing the biliary tree and pancreas with the help of contrast material.

Complications of ERCP:

  • Pancreatitis (~5%)
  • Hemorrhage
  • Pneumoperitoneum and/or pneumoretroperitoneum due to perforation
  • Cholangitis
  • Pneumobilia

Contraindications of ERCP:

  • Unstable patient
  • Structural abnormalities of esphagus, stomach or duodenum
  • Coagulopathy
Case courtesy of Dr Adriana Dubbeldam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/22197">rID: 22197</a>

References

  1. Tenner S, Baillie J, DeWitt J, Vege SS, American College of Gastroenterology (2013). "American College of Gastroenterology guideline: management of acute pancreatitis". Am J Gastroenterol. 108 (9): 1400–15, 1416. doi:10.1038/ajg.2013.218. PMID 23896955.
  2. Tenner S (2004). "Initial management of acute pancreatitis: critical issues during the first 72 hours". Am. J. Gastroenterol. 99 (12): 2489–94. doi:10.1111/j.1572-0241.2004.40329.x. PMID 15571599.
  3. Acosta JM, Ledesma CL (1974). "Gallstone migration as a cause of acute pancreatitis". N. Engl. J. Med. 290 (9): 484–7. doi:10.1056/NEJM197402282900904. PMID 4810815.
  4. Fan ST, Lai EC, Mok FP, Lo CM, Zheng SS, Wong J (1993). "Early treatment of acute biliary pancreatitis by endoscopic papillotomy". N. Engl. J. Med. 328 (4): 228–32. doi:10.1056/NEJM199301283280402. PMID 8418402.
  5. Fölsch UR, Nitsche R, Lüdtke R, Hilgers RA, Creutzfeldt W (1997). "Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis. The German Study Group on Acute Biliary Pancreatitis". N. Engl. J. Med. 336 (4): 237–42. doi:10.1056/NEJM199701233360401. PMID 8995085.
  6. Arguedas MR, Dupont AW, Wilcox CM (2001). "Where do ERCP, endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography fit in the management of acute biliary pancreatitis? A decision analysis model". Am. J. Gastroenterol. 96 (10): 2892–9. doi:10.1111/j.1572-0241.2001.04244.x. PMID 11693323.




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