Diagnostic Criteria in Predicting a Biliary Origin of Acute Pancreatitis in the Era of Endoscopic Ultrasound: Multicentre Prospective Evaluation of 213 Patients

Vol. 5, No. 4-5, 2005

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Original Paper

Diagnostic Criteria in Predicting a Biliary Origin of Acute Pancreatitis in the Era of Endoscopic Ultrasound: Multicentre Prospective Evaluation of 213 Patients
Philippe Lévy^a, Arnaud Boruchowicz^b, Patrick Hastier^c, Alexandre Pariente^d, Thierry Thévenot^e, Jean Louis Frossard^f, Louis Buscail^g, François Mauvais^h, Jean Claude Duchmannⁱ, Alain Courrier^j, Philippe Bulois^k, Jean Louis Gineston^l, Marc Barthet^m, Henri Lichtⁿ, Dermot O'Toole^a, Philippe Ruszniewski^a

^aFédération médico-chirurgicale d'hépato-gastroentérologie, AP-HP, Hôpital Beaujon, Clichy,
^bService de Gastroentérologie, Centre Hospitalier Régional, Valenciennes,
^cService de Gastroentérologie, Centre Hospitalier Régional, Pau;
^dService de Gastroentérologie, Centre Hospitalier Universitaire, Nice, and
^eService de Gastroentérologie, Centre Hospitalier Régional, Cambrai, France;
^fCentre Hospitalier Régional Universitaire, Genève, Switzerland;
^gService de Gastroentérologie, Centre Hospitalier Universitaire, Toulouse,
^hCentre Hospitalier Régional, Beauvais;
ⁱCentre Hospitalier Régional, Compiègne,
^jCentre Hospitalier Régional, Metz,
^kCentre Hospitalier Universitaire, Lille,
^lCentre Hospitalier Régional, Rodez,
^mCentre Hospitalier Universitaire, Marseille, and
ⁿCentre Hospitalier Régional, Saint Denis, France

Address of Corresponding Author

Pancreatology 2005;5:450-456 (DOI: 10.1159/000086547)

Key Words

Acute pancreatitis
Biliary lithiasis
Endoscopic ultrasonography

Abstract

Background: No study on bioclinical criteria predicting a biliary origin for acute pancreatitis has included endosonography as a reference examination. Re-examination of bioclinical parameters deserves consideration in the era where other causes are known (e.g. hereditary, autoimmune). Aim and Methods: To determine the performance of bioclinical markers in predicting a biliary origin of acute pancreatitis where the diagnosis of biliary lithiasis was established or ruled out using endosonography. Only patients with a first acute episode of pancreatitis were included. Results: 213 patients (male: 55%; median age: 56 years) were prospectively included in 14 centres. Causes of acute pancreatitis were: biliary (62%), alcoholic (25%), other (13%). Delay between symptom-onset and admission was <48 h in 80%. Endosonography was the sole method establishing the diagnosis of biliary pancreatitis in 15% of patients. At univariate analysis, age, female sex, declared alcohol consumption, elevated aspartate and alanine transaminases on admission, gammaglutamyl transferase, alkaline phosphatase, total bilirubin, lipase, mean corpuscular volume were predictive of a biliary origin. Only age (p < 0.0001), sex (p < 0.0008) and alanine transaminase (p < 0.0004) remained significant at multivariate analysis. At age 50, the respective sensitivity and specificity were 73 and 65%. With an elevated alanine transaminase at 2 times the upper limit of normal range, the respective sensitivity and specificity were 74 and 84%. The probability of a biliary origin of acute pancreatitis could be estimated by the following formula: = 1/1 + exp(4.6967 - 0.0656 x age + 1.1208 x sex - 0.6909 x alanine transaminase). Conclusion: When endosonography is performed to confirm or exclude a biliary origin of acute pancreatitis, age, sex and alanine transaminase at admission are the only factors predictive of a biliary cause.

Author Contacts

Prof. Philippe Lévy
Fédération médico-chirurgicale d'hépato-gastroentérologie, Hôpital Beaujon
FR-92118 Clichy Cedex (France)
Tel. +33 1 40 87 52 15, Fax +33 1 42 70 37 84
E-Mail philippe.levy@bjn.ap-hop-paris.fr

Article Information

Received: September 20, 2004
Accepted after revision: February 3, 2005
Published online: June 28, 2005
Number of Print Pages : 7
Number of Figures : 0, Number of Tables : 0, Number of References : 40

Medline Abstract (ID 15985771)

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