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  • Review Article
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Etiology and diagnosis of acute biliary pancreatitis

Nature Reviews Gastroenterology & Hepatology volume 7, pages 495–502 (2010)Cite this article

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Abstract

Establishing a biliary etiology in acute pancreatitis is clinically important because of the potential need for invasive treatment, such as endoscopic retrograde cholangiopancreatography. The etiology of acute biliary pancreatitis (ABP) is multifactorial and complex. Passage of small gallbladder stones or biliary sludge through the ampulla of Vater seems to be important in the pathogenesis of ABP. Other factors, such as anatomical variations associated with an increased biliopancreatic reflux, bile and pancreatic juice exclusion from the duodenum, and genetic factors might contribute to the development of ABP. A diagnosis of a biliary etiology in acute pancreatitis is supported by both laboratory and imaging investigations. An increased serum level of alanine aminotransferase (>1.0 µkat/l) is associated with a high probability of gallstone pancreatitis (positive predictive value 80–90%). Confirmation of choledocholithiasis is most accurately obtained using endoscopic ultrasonography or magnetic resonance cholangiopancreatography. This Review discusses the pathogenesis of ABP and the clinical techniques used to predict and establish a biliary origin in patients with suspected ABP.

Key Points

  • A key feature of the pathogenesis of acute biliary pancreatitis is transient or persistent ampullary obstruction

  • Obstruction is associated with pancreatic and biliary ductal anatomy, gallstone-related factors, biliopancreatic reflux and duodenal bile and pancreatic juice exclusion

  • The role of genetics in the pathogenesis of acute biliary pancreatitis is not well established

  • Elevated levels of alanine aminotransferase (>1.0 µkat/l) in nonobese patients without a medical history of heavy drinking of alcoholic beverages can indicate pancreatitis with a biliary origin

  • Magnetic resonance cholangiopancreatography and endoscopic ultrasonography aid diagnosis of acute biliary pancreatitis in patients who are obese, are alcohol dependent, or have normal levels of liver enzymes

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Figure 1: Pathogenesis of acute biliary pancreatitis.
Figure 2: Predicting the biliary origin of acute pancreatitis.

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References

  1. Frey, C. F., Zhou, H., Harvey, D. J. & White, R. H. The incidence and case-fatality rates of acute biliary, alcoholic, and idiopathic pancreatitis in California, 1994–2001. Pancreas 33, 336–344 (2006).

    Article  PubMed  Google Scholar 

  2. Mergener, K. & Baillie, J. Endoscopic treatment for acute biliary pancreatitis. When and in whom? Gastroenterol. Clin. North Am. 28, 601–613 (1999).

    Article  CAS  PubMed  Google Scholar 

  3. Toh, S. K., Phillips, S. & Johnson, C. D. A prospective audit against national standards of the presentation and management of acute pancreatitis in the South of England. Gut 46, 239–243 (2000).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Yadav, D. & Lowenfels, A. B. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas 33, 323–330 (2006).

    Article  PubMed  Google Scholar 

  5. van Erpecum, K. J. Gallstone disease. Complications of bile-duct stones: acute cholangitis and pancreatitis. Best Pract. Res. Clin. Gastroenterol. 20, 1139–1152 (2006).

    Article  PubMed  Google Scholar 

  6. Howard, J. M. in Surgical Diseases of the Pancreas 265–283 (Lea and Febiger, Philadelphia, 1987).

    Google Scholar 

  7. Bernard, C. in Lecons de Physiologie Experimentale 278 (J. B. Boiliere, Paris, 1856).

    Google Scholar 

  8. Opie, E. L. The aetiology of acute haemorrhagic pancreatitis. Bull. Johns Hopkins Hosp. 12, 182–188 (1901).

    Google Scholar 

  9. Halstead, W. S. Retrojection of bile into the pancreas, a cause of acute hemorrhagic pancreatitis. Bull. Johns Hopkins Hosp. 12, 179–181 (1901).

    Google Scholar 

  10. Acosta, J. M., Pellegrini, C. A. & Skinner, D. B. Etiology and pathogenesis of acute biliary pancreatitis. Surgery 88, 118–125 (1980).

    CAS  PubMed  Google Scholar 

  11. Neoptolemos, J. P. The theory of 'persisting' common bile duct stones in severe gallstone pancreatitis. Ann. R. Coll. Surg. Engl. 71, 326–331 (1989).

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Acosta, J. M. & Ledesma, C. L. Gallstone migration as a cause of acute pancreatitis. N. Engl. J. Med. 290, 484–487 (1974).

    Article  CAS  PubMed  Google Scholar 

  13. Acosta, M. J., Rossi, R. & Ledesma, C. L. The usefulness of stool screening for diagnosing cholelithiasis in acute pancreatitis. A description of the technique. Am. J. Dig. Dis. 22, 168–172 (1977).

    Article  CAS  PubMed  Google Scholar 

  14. Kaiser, A. M., Saluja, A. K. & Steer, M. L. Repetitive short-term obstructions of the common bile-pancreatic duct induce severe acute pancreatitis in the opossum. Dig. Dis. Sci. 44, 1653–1661 (1999).

    Article  CAS  PubMed  Google Scholar 

  15. Senninger, N., Moody, F. G., Coelho, J. C. & Van Buren, D. H. The role of biliary obstruction in the pathogenesis of acute pancreatitis in the opossum. Surgery 99, 688–693 (1986).

    CAS  PubMed  Google Scholar 

  16. Schleicher, C., Baas, J. C., Elser, H. & Senninger, N. Reticuloendothelial system blockade promotes progression from mild to severe acute pancreatitis in the opossum. Ann. Surg. 233, 528–536 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Senninger, N. Bile-induced pancreatitis. Eur. Surg. Res. 24 (Suppl. 1), 68–73 (1992).

    Article  PubMed  Google Scholar 

  18. Senninger, N. Functional relation of bile and the pancreas. Z. Gastroenterol. 27 (Suppl. 3), 17–18 (1989).

    PubMed  Google Scholar 

  19. Runkel, N. S., Rodriguez, L. F. & Moody, F. G. Mechanisms of sepsis in acute pancreatitis in opossums. Am. J. Surg. 169, 227–232 (1995).

    Article  CAS  PubMed  Google Scholar 

  20. Pain, J. A. & Bailey, M. E. Measurement of operative plasma endotoxin levels in jaundiced and non-jaundiced patients. Eur. Surg. Res. 19, 207–216 (1987).

    Article  CAS  PubMed  Google Scholar 

  21. Rünzi, M. et al. Early ductal decompression prevents the progression of biliary pancreatitis: an experimental study in the opossum. Gastroenterology 105, 157–164 (1993).

    Article  PubMed  Google Scholar 

  22. Acosta, J. M., Rossi, R., Galli, O. M., Pellegrini, C. A. & Skinner, D. B. Early surgery for acute gallstone pancreatitis: evaluation of a systematic approach. Surgery 83, 367–370 (1978).

    CAS  PubMed  Google Scholar 

  23. Acosta, J. M. et al. Early ductal decompression versus conservative management for gallstone pancreatitis with ampullary obstruction: a prospective randomized clinical trial. Ann. Surg. 243, 33–40 (2006).

    Article  PubMed  PubMed Central  Google Scholar 

  24. Stone, H. H., Fabian, T. C. & Dunlop, W. E. Gallstone pancreatitis: biliary tract pathology in relation to time of operation. Ann. Surg. 194, 305–312 (1981).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Neoptolemos, J. P. et al. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet 2, 979–983 (1988).

    Article  CAS  PubMed  Google Scholar 

  26. Wilson, C., Imrie, C. W. & Carter, D. C. Fatal acute pancreatitis. Gut 29, 782–788 (1988).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Lee, S. P., Maher, K. & Nicholls, J. F. Origin and fate of biliary sludge. Gastroenterology 94, 170–176 (1988).

    Article  CAS  PubMed  Google Scholar 

  28. Lee, S. P., Nicholls, J. F. & Park, H. Z. Biliary sludge as a cause of acute pancreatitis. N. Engl. J. Med. 326, 589–593 (1992).

    Article  CAS  PubMed  Google Scholar 

  29. Sackmann, M. et al. The Munich Gallbladder Lithotripsy Study. Results of the first 5 years with 711 patients. Ann. Intern. Med. 114, 290–296 (1991).

    Article  CAS  PubMed  Google Scholar 

  30. Hammarström, L. E., Stridbeck, H. & Ihse, I. Effect of endoscopic sphincterotomy and interval cholecystectomy on late outcome after gallstone pancreatitis. Br. J. Surg. 85, 333–336 (1998).

    Article  PubMed  Google Scholar 

  31. Siegel, J. H., Veerappan, A., Cohen, S. A. & Kasmin, F. E. Endoscopic sphincterotomy for biliary pancreatitis: an alternative to cholecystectomy in high-risk patients. Gastrointest. Endosc. 40, 573–575 (1994).

    Article  CAS  PubMed  Google Scholar 

  32. Murayama, K. M., Drew, J. B., Yokoo, H. & Joehl, R. J. Bile exclusion from the gut exacerbates acute pancreatitis caused by pancreatic duct obstruction in rats. Pancreas 6, 175–181 (1991).

    Article  CAS  PubMed  Google Scholar 

  33. Murayama, K. M. et al. Increased circulating cholecystokinin in obstruction-induced acute pancreatitis. I. Bile duct obstruction with and without pancreatic duct obstruction. J. Surg. Res. 54, 126–131 (1993).

    Article  CAS  PubMed  Google Scholar 

  34. Miyasaka, K. & Funakoshi, A. Luminal feedback regulation, monitor peptide, CCK-releasing peptide, and CCK receptors. Pancreas 16, 277–283 (1998).

    Article  CAS  PubMed  Google Scholar 

  35. Samuel, I. Bile and pancreatic juice exclusion activates acinar stress kinases and exacerbates gallstone pancreatitis. Surgery 143, 434–440 (2008).

    Article  PubMed  Google Scholar 

  36. Saluja, A., Logsdon, C. & Garg, P. Direct versus indirect action of cholecystokinin on human pancreatic acinar cells: is it time for a judgment after a century of trial? Gastroenterology 135, 357–360 (2008).

    Article  CAS  PubMed  Google Scholar 

  37. Murphy, J. A. et al. Direct activation of cytosolic Ca2+ signaling and enzyme secretion by cholecystokinin in human pancreatic acinar cells. Gastroenterology 135, 632–641 (2008).

    Article  CAS  PubMed  Google Scholar 

  38. Samuel, I., Toriumi, Y., Zaheer, A. & Joehl, R. J. Mechanism of acute pancreatitis exacerbation by enteral bile-pancreatic juice exclusion. Pancreatology 4, 527–532 (2004).

    Article  PubMed  Google Scholar 

  39. Samuel, I., Zaheer, S. & Zaheer, A. Bile-pancreatic juice exclusion increases p38MAPK activation and TNF-α production in ligation-induced acute pancreatitis in rats. Pancreatology 5, 20–26 (2005).

    Article  CAS  PubMed  Google Scholar 

  40. Samuel, I., Yorek, M. A., Zaheer, A. & Fisher, R. A. Bile-pancreatic juice exclusion promotes Akt/NF-κB activation and chemokine production in ligation-induced acute pancreatitis. J. Gastrointest. Surg. 10, 950–959 (2006).

    Article  PubMed  Google Scholar 

  41. Armstrong, C. P., Taylor, T. V., Jeacock, J. & Lucas, S. The biliary tract in patients with acute gallstone pancreatitis. Br. J. Surg. 72, 551–555 (1985).

    Article  CAS  PubMed  Google Scholar 

  42. Houssin, D., Castaing, D., Lemoine, J. & Bismuth, H. Microlithiasis of the gallbladder. Surg. Gynecol. Obstet. 157, 20–24 (1983).

    CAS  PubMed  Google Scholar 

  43. Farinon, A. M., Ricci, G. L., Sianesi, M., Percudani, M. & Zanella, E. Physiopathologic role of microlithiasis in gallstone pancreatitis. Surg. Gynecol. Obstet. 164, 252–256 (1987).

    CAS  PubMed  Google Scholar 

  44. Kelly, T. R. Gallstone pancreatitis. Local predisposing factors. Ann. Surg. 200, 479–485 (1984).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Diehl, A. K., Holleman, D. R. Jr, Chapman, J. B., Schwesinger, W. H. & Kurtin, W. E. Gallstone size and risk of pancreatitis. Arch. Intern. Med. 157, 1674–1678 (1997).

    Article  CAS  PubMed  Google Scholar 

  46. Kim, W. H., Lee, K. J., Yoo, B. M., Kim, J. H. & Kim, M. W. Relation between the risk of gallstone pancreatitis and characteristics of gallstone in Korea. Hepatogastroenterology 47, 343–345 (2000).

    CAS  PubMed  Google Scholar 

  47. McMahon, M. J. & Shefta, J. R. Physical characteristics of gallstones and the calibre of the cystic duct in patients with acute pancreatitis. Br. J. Surg. 67, 6–9 (1980).

    Article  CAS  PubMed  Google Scholar 

  48. Venneman, N. G. et al. Small gallstones are associated with increased risk of acute pancreatitis: potential benefits of prophylactic cholecystectomy? Am. J. Gastroenterol. 100, 2540–2550 (2005).

    Article  PubMed  Google Scholar 

  49. Venneman, N. G. et al. Small gallstones, preserved gallbladder motility, and fast crystalization are associated with pancreatitis Hepatology 41, 738–746 (2005).

    Article  CAS  PubMed  Google Scholar 

  50. Sugiyama, M. & Atomi, Y. Risk factors for acute biliary pancreatitis. Gastrointest. Endosc. 60, 210–212 (2004).

    Article  PubMed  Google Scholar 

  51. Arendt, R., Liebe, S. & Erdmann, K. Biliary pancreatitis—pathogenesis, therapy, results. Z. Gesamte. Inn. Med. 44, 401–404 (1989).

    CAS  PubMed  Google Scholar 

  52. Nitsche, R. & Fölsch, U. R. Role of ERCP and endoscopic sphincterotomy in acute pancreatitis. Baillieres Best Pract. Res. Clin. Gastroenterol. 13, 331–343 (1999).

    Article  CAS  PubMed  Google Scholar 

  53. Arendt, T. et al. Biliary pancreatic reflux-induced acute pancreatitis—myth or possibility? Eur. J. Gastroenterol. Hepatol. 11, 329–335 (1999).

    Article  CAS  PubMed  Google Scholar 

  54. Lüthen, R. E., Niederau, C. & Grendell, J. H. Effects of bile and pancreatic digestive enzymes on permeability of the pancreatic duct system in rabbits. Pancreas 8, 671–681 (1993).

    Article  PubMed  Google Scholar 

  55. Nakamura, T., Okada, A., Higaki, J., Tojo, H. & Okamoto, M. Pancreaticobiliary maljunction-associated pancreatitis: an experimental study on the activation of pancreatic phospholipase A2. World J. Surg. 20, 543–550 (1996).

    Article  CAS  PubMed  Google Scholar 

  56. Sugiyama, M., Atomi, Y. & Kuroda, A. Pancreatic disorders associated with anomalous pancreaticobiliary junction. Surgery 126, 492–497 (1999).

    Article  CAS  PubMed  Google Scholar 

  57. Jones, B. A., Salsberg, B. B., Mehta, M. H. & Bohnen, J. M. Common pancreaticobiliary channels and their relationship to gallstone size in gallstone pancreatitis. Ann. Surg. 205, 123–125 (1987).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Kamisawa, T. et al. The presence of a common channel and associated pancreaticobiliary diseases: a prospective ERCP study. Dig. Liver Dis. 39, 173–179 (2007).

    Article  CAS  PubMed  Google Scholar 

  59. Uomo, G., Rabitti, P. G., Laccetti, M. & Visconti, M. Pancreatico-choledochal junction and pancreatic duct system morphology in acute biliary pancreatitis. A prospective study with early ERCP. Int. J. Pancreatol. 13, 187–191 (1993).

    Article  CAS  PubMed  Google Scholar 

  60. Nowak, A., Nowakowska-Dutawa, E. & Rybicka, J. Patency of the Santorini duct and acute biliary pancreatitis. A prospective ERCP study. Endoscopy 22, 124–126 (1990).

    Article  CAS  PubMed  Google Scholar 

  61. Kamisawa, T. et al. Clinical significance of the accessory pancreatic duct. Hepatogastroenterology 50, 2196–2198 (2003).

    PubMed  Google Scholar 

  62. Arendt, T. et al. Santorini's duct—risk factor for acute pancreatitis or protective morphologic variant? Experiments in rabbits. Eur. J. Gastroenterol. Hepatol. 9, 569–573 (1997).

    Article  CAS  PubMed  Google Scholar 

  63. Vonlaufen, A., Wilson, J. S. & Apte, M. V. Molecular mechanisms of pancreatitis: current opinion. J. Gastroenterol. Hepatol. 23, 1339–1348 (2008).

    Article  CAS  PubMed  Google Scholar 

  64. Keim, V. Role of genetic disorders in acute recurrent pancreatitis. World J. Gastroenterol. 14, 1011–1015 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  65. O'Reilly, D. A. et al. The SPINK1 N34S variant is associated with acute pancreatitis. Eur. J. Gastroenterol. Hepatol. 20, 726–731 (2008).

    Article  CAS  PubMed  Google Scholar 

  66. Fein, F., Hermelin, B., Becker, M. C., Felix, S. & Carbonnel, F. Acute recurrent biliary pancreatitis associated with the ABCB4 gene mutation. Gastroenterol. Clin. Biol. 31, 106–109 (2007).

    Article  PubMed  Google Scholar 

  67. Ockenga, J. et al. Mutations of the cystic fibrosis gene, but not cationic trypsinogen gene, are associated with recurrent or chronic idiopathic pancreatitis. Am. J. Gastroenterol. 95, 2061–2067 (2000).

    Article  CAS  PubMed  Google Scholar 

  68. Pelletier, A. L. et al. CFTR gene mutation in patients with apparently idiopathic pancreatitis: lack of phenotype–genotype correlation. Pancreatology 10, 158–164 (2010).

    Article  CAS  PubMed  Google Scholar 

  69. Cavestro, G. M. et al. Connections between genetics and clinical data: role of MCP-1, CFTR, and SPINK-1 in the setting of acute, acute recurrent, and chronic pancreatitis. Am. J. Gastroenterol. 105, 199–206 (2010).

    Article  PubMed  Google Scholar 

  70. Sarr, M. G. Revision of the Atlanta classification of acute pancreatitis. The Pancreas Club[online], (2008).

  71. Frank, B. & Gottlieb, K. Amylase normal, lipase elevated: is it pancreatitis? A case series and review of the literature. Am. J. Gastroenterol. 94, 463–469 (1999).

    CAS  PubMed  Google Scholar 

  72. Lankisch, P. G., Burchard-Reckert, S. & Lehnick, D. Underestimation of acute pancreatitis: patients with only a small increase in amylase/lipase levels can also have or develop severe acute pancreatitis. Gut 44, 542–544 (1999).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Dougherty, S. H., Saltzstein, E. C., Peacock, J. B., Mercer, L. C. & Cano, P. Rapid resolution of high level hyperamylasemia as a guide to clinical diagnosis and timing of surgical treatment in patients with gallstones. Surg. Gynecol. Obstet. 166, 491–496 (1988).

    CAS  PubMed  Google Scholar 

  74. Montalto, G. et al. Serum trypsin in chronic renal failure and transplant patients. Am. J. Gastroenterol. 87, 1175–1179 (1992).

    CAS  PubMed  Google Scholar 

  75. Warshaw, A. L. & Lee, K. H. Characteristic alterations of serum isoenzymes of amylase in diseases of liver, pancreas, salivary gland, lung, and genitalia. J. Surg. Res. 22, 362–369 (1977).

    Article  CAS  PubMed  Google Scholar 

  76. McMahon, M. J. & Pickford, I. R. Biochemical prediction of gallstones early in an attack of acute pancreatitis. Lancet 2, 541–543 (1979).

    Article  CAS  PubMed  Google Scholar 

  77. Dholakia, K., Pitchumoni, C. S. & Agarwal, N. How often are liver function tests normal in acute biliary pancreatitis? J. Clin. Gastroenterol. 38, 81–83 (2004).

    Article  PubMed  Google Scholar 

  78. Davidson, B. R., Neoptolemos, J. P., Leese, T. & Carr-Locke, D. L. Biochemical prediction of gallstones in acute pancreatitis: a prospective study of three systems. Br. J. Surg. 75, 213–215 (1988).

    Article  CAS  PubMed  Google Scholar 

  79. Stimac, D., Lenac, T. & Marusic, Z. A scoring system for early differentiation of the etiology of acute pancreatitis. Scand. J. Gastroenterol. 33, 209–211 (1998).

    Article  CAS  PubMed  Google Scholar 

  80. Tenner, S., Dubner, H. & Steinberg, W. Predicting gallstone pancreatitis with laboratory parameters: a meta-analysis. Am. J. Gastroenterol. 89, 1863–1866 (1994).

    CAS  PubMed  Google Scholar 

  81. Grau, F. et al. Usefulness of alanine and aspartate aminotransferases in the diagnosis of microlithiasis in idiopathic acute pancreatitis. Int. J. Pancreatol. 25, 107–111 (1999).

    Article  CAS  PubMed  Google Scholar 

  82. Kazmierczak, S. C., Catrou, P. G. & Van, L. F. Enzymatic markers of gallstone-induced pancreatitis identified by ROC curve analysis, discriminant analysis, logistic regression, likelihood ratios, and information theory. Clin. Chem. 41, 523–531 (1995).

    Article  CAS  PubMed  Google Scholar 

  83. Ammori, B. J., Boreham, B., Lewis, P. & Roberts, S. A. The biochemical detection of biliary etiology of acute pancreatitis on admission: a revisit in the modern era of biliary imaging. Pancreas 26, e32–e35 (2003).

    Article  CAS  PubMed  Google Scholar 

  84. Levy, P. et al. Diagnostic criteria in predicting a biliary origin of acute pancreatitis in the era of endoscopic ultrasound: multicentre prospective evaluation of 213 patients. Pancreatology 5, 450–456 (2005).

    Article  PubMed  Google Scholar 

  85. Liu, C. L. et al. Clinico-biochemical prediction of biliary cause of acute pancreatitis in the era of endoscopic ultrasonography. Aliment. Pharmacol. Ther. 22, 423–431 (2005).

    Article  CAS  PubMed  Google Scholar 

  86. Schreuder, T. C., Verwer, B. J., van Nieuwkerk, C. M. & Mulder, C. J. Nonalcoholic fatty liver disease: an overview of current insights in pathogenesis, diagnosis and treatment. World J. Gastroenterol. 14, 2474–2486 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Yeo, C. J. Pancreatic pseudocysts, ascites, and fistulas. Curr. Opin. Gen. Surg. 173–178 (1994).

  88. Arvanitakis, M. et al. Staging of severity and prognosis of acute pancreatitis by computed tomography and magnetic resonance imaging—a comparative study. Dig. Liver Dis. 39, 473–482 (2007).

    Article  CAS  PubMed  Google Scholar 

  89. Stimac, D., Krznaric, Z. I., Radic, M. & Zuvic-Butorac, M. Outcome of the biliary acute pancreatitis is not associated with body mass index. Pancreas 34, 165–166 (2007).

    Article  PubMed  Google Scholar 

  90. Piironen, A. Severe acute pancreatitis: contrast-enhanced CT and MRI features. Abdom. Imaging 26, 225–233 (2001).

    Article  CAS  PubMed  Google Scholar 

  91. Ward, J., Chalmers, A. G., Guthrie, A. J., Larvin, M. & Robinson, P. J. T2-weighted and dynamic enhanced MRI in acute pancreatitis: comparison with contrast enhanced CT. Clin. Radiol. 52, 109–114 (1997).

    Article  CAS  PubMed  Google Scholar 

  92. Rizk, M. K. & Gerke, H. Utility of endoscopic ultrasound in pancreatitis: a review. World J. Gastroenterol. 13, 6321–6326 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  93. Balthazar, E. J., Robinson, D. L., Megibow, A. J. & Ranson, J. H. Acute pancreatitis: value of CT in establishing prognosis. Radiology 174, 331–336 (1990).

    Article  CAS  PubMed  Google Scholar 

  94. De Waele, J. J. et al. Extrapancreatic inflammation on abdominal computed tomography as an early predictor of disease severity in acute pancreatitis: evaluation of a new scoring system. Pancreas 34, 185–190 (2007).

    Article  PubMed  Google Scholar 

  95. Goodman, A. J., Neoptolemos, J. P., Carr-Locke, D. L., Finlay, D. B. & Fossard, D. P. Detection of gall stones after acute pancreatitis. Gut 26, 125–132 (1985).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  96. Neoptolemos, J. P. The urgent diagnosis of gallstones in acute pancreatitis: a prospective study of three methods. Br. J. Surg. 71, 230–233 (1984).

    Article  CAS  PubMed  Google Scholar 

  97. Chak, A. et al. Prospective assessment of the utility of EUS in the evaluation of gallstone pancreatitis. Gastrointest. Endosc. 49, 599–604 (1999).

    Article  CAS  PubMed  Google Scholar 

  98. Sugiyama, M. & Atomi, Y. Acute biliary pancreatitis: the roles of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography. Surgery 124, 14–21 (1998).

    Article  CAS  PubMed  Google Scholar 

  99. Moon, J. H. et al. The detection of bile duct stones in suspected biliary pancreatitis: comparison of MRCP, ERCP, and intraductal US. Am. J. Gastroenterol. 100, 1051–1057 (2005).

    Article  PubMed  Google Scholar 

  100. Makary, M. A. et al. The role of magnetic resonance cholangiography in the management of patients with gallstone pancreatitis. Ann. Surg. 241, 119–124 (2005).

    Article  PubMed  PubMed Central  Google Scholar 

  101. Bruno, M. J. Endoscopic ultrasonography. Endoscopy 38, 1098–1105 (2006).

    Article  CAS  PubMed  Google Scholar 

  102. Liu, C. L. et al. Comparison of early endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in the management of acute biliary pancreatitis: a prospective randomized study. Clin. Gastroenterol. Hepatol. 3, 1238–1244 (2005).

    Article  PubMed  Google Scholar 

  103. Stabuc, B. et al. Acute biliary pancreatitis: detection of common bile duct stones with endoscopic ultrasound. Eur. J. Gastroenterol. Hepatol. 20, 1171–1175 (2008).

    Article  PubMed  Google Scholar 

  104. Sugiyama, M., Wada, N., Atomi, Y., Kuroda, A. & Muto, T. Diagnosis of acute pancreatitis: value of endoscopic sonography. AJR Am. J. Roentgenol. 165, 867–872 (1995).

    Article  CAS  PubMed  Google Scholar 

  105. Tse, F., Barkun, J. S. & Barkun, A. N. The elective evaluation of patients with suspected choledocholithiasis undergoing laparoscopic cholecystectomy. Gastrointest. Endosc. 60, 437–448 (2004).

    Article  PubMed  Google Scholar 

  106. Hallal, A. H. et al. Magnetic resonance cholangiopancreatography accurately detects common bile duct stones in resolving gallstone pancreatitis. J. Am. Coll. Surg. 200, 869–875 (2005).

    Article  PubMed  Google Scholar 

  107. Kimura, Y. et al. JPN Guidelines for the management of acute pancreatitis: treatment of gallstone-induced acute pancreatitis. J. Hepatobiliary Pancreat. Surg. 13, 56–60 (2006).

    Article  PubMed  PubMed Central  Google Scholar 

  108. Ouwendijk, R. Dutch guidelines on acute pancreatitis [Dutch]. Nederlandse Internisten Vereniging [online], (2005).

    Google Scholar 

  109. Forsmark, C. E. & Baillie, J. AGA Institute technical review on acute pancreatitis. Gastroenterology 132, 2022–2044 (2007).

    Article  CAS  PubMed  Google Scholar 

  110. UK guidelines for the management of acute pancreatitis. Gut 54 (Suppl. 3), iii1–iii9 (2005).

  111. Liu, C. L., Lo, C. M., Chan, J. K., Poon, R. T. & Fan, S. T. EUS for detection of occult cholelithiasis in patients with idiopathic pancreatitis. Gastrointest. Endosc. 51, 28–32 (2000).

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, VU-University Medical Center, P. O. Box 7057, Amsterdam, 1007, MB, The Netherlands

    Erwin J. M. van Geenen, Pranav Bhagirath & Chris J. J. Mulder

  2. Department of Gastrointestinal Surgery, VU-University Medical Center, P. O. Box 7057, Amsterdam, 1007, MB, The Netherlands

    Donald L. van der Peet

  3. Department of Gastroenterology and Hepatology, Erasmus University Medical Center, P. O. Box 2040, Rotterdam, 3000, CA, The Netherlands

    Marco J. Bruno

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Contributions

E. J. M. van Geenen researched the data for the article. Both E. J. M. van Geenen and M. J. Bruno provided a substantial contribution to discussion of the content and contributed equally to the writing of this article. E. J. M. van Geenen, D. L. van der Peet, P. Bhagirath, C. J. J. Mulder and M. J. Bruno contributed equally to reviewing or editing the manuscript before submission.

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Correspondence to Erwin J. M. van Geenen.

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van Geenen, E., van der Peet, D., Bhagirath, P. et al. Etiology and diagnosis of acute biliary pancreatitis. Nat Rev Gastroenterol Hepatol 7, 495–502 (2010). https://doi.org/10.1038/nrgastro.2010.114

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