Prospective multicentre study of indications for surgery in patients with idiopathic acute pancreatitis following endoscopic ultrasonography (PICUS)

DS Umans, HC Timmerhuis, MPGF Anten, A Bhalla, RA Bijlsma, L Boxhoorn, MA Brink, MJ Bruno, WL Curvers, BC van Eijck, GW Erkelens, EJM van Geenen, WL Hazen, C Hoge, L Hol, A Inderson, LM Kager, SD Kuiken, LE Perk, R QuispelTEH Römkens, CJS Weiland, AY Thijssen, NG Venneman, RC Verdonk, RLJ van Wanrooij, B Witteman, MG Besselink, JE van Hooft*, Dutch Pancreatitis Study Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
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Cholecystectomy in patients with idiopathic acute pancreatitis (IAP) is controversial. A randomized trial found cholecystectomy to reduce the recurrence rate of IAP but did not include preoperative endoscopic ultrasonography (EUS). As EUS is effective in detecting gallstone disease, cholecystectomy may be indicated only in patients with gallstone disease. This study aimed to determine the diagnostic value of EUS in patients with IAP, and the rate of recurrent pancreatitis in patients in whom EUS could not determine the aetiology (EUS-negative IAP).


This prospective multicentre cohort study included patients with a first episode of IAP who underwent outpatient EUS. The primary outcome was detection of aetiology by EUS. Secondary outcomes included adverse events after EUS, recurrence of pancreatitis, and quality of life during 1-year follow-up.


After screening 957 consecutive patients with acute pancreatitis from 24 centres, 105 patients with IAP were included and underwent EUS. In 34 patients (32 per cent), EUS detected an aetiology: (micro)lithiasis and biliary sludge (23.8 per cent), chronic pancreatitis (6.7 per cent), and neoplasms (2.9 per cent); 2 of the latter patients underwent pancreatoduodenectomy. During 1-year follow-up, the pancreatitis recurrence rate was 17 per cent (12 of 71) among patients with EUS-negative IAP versus 6 per cent (2 of 34) among those with positive EUS. Recurrent pancreatitis was associated with poorer quality of life.


EUS detected an aetiology in a one-third of patients with a first episode of IAP, requiring mostly cholecystectomy or pancreatoduodenectomy. The role of cholecystectomy in patients with EUS-negative IAP remains uncertain and warrants further study.
Original languageEnglish
Pages (from-to)1877–1882
Number of pages6
JournalBritish Journal of Surgery
Issue number12
Early online date9 Oct 2023
Publication statusPublished - 1 Dec 2023

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© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.


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