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Reste-t-il une place pour l’échoendoscopie dans le bilan étiologique de la pancréatite aiguë?

Is there a role for endosonography in acute pancreatitis?

  • Published:
Acta Endoscopica

Résumé

Le diagnostic d’une pancréatite alguë repose principalement sur l’histoire clinique et les examens biologiques. Une imagerie et des investigations complémentaires sont souvent nécessaires pour confirmer le diagnostic, pour déterminer l’étiologie de l’affection et pour décrire les complications potentielles. Alors qu’il a été bien démontré que l’échoendoscopie digestive (EED) est utile dans le diagnostic de plusieurs étiologies de pancréatite aiguë, peu d’études ont comparé les résultats de l’EED avec d’autres techniques d’imagerie dans cette indication particulière. L’EED est une procédure particulièrement sensible et spécifique dans le diagnostic de la lithiase biliaire et cholédocienne, dans la détection des obstructions distales biliaires et pancréatiques et dans la confirmation du diagnostic de pancréatite, lorsque l’imagerie conventionnelle n’est pas concluante. L’EED avec ponction à l’aiguille fine peut aussi jouer un rôle déterminant dans le diagnostic différentiel parfois difficile entre un processus inflammatoire et une pathologie néoplasique. Dans les pancréatites aiguës sévères, I’EED a l’avantage d’être une unité mobile et de pouvoir être réalisée au chevet du malade aux soins intensifs. L’examen peut cependant être limité par l’œdème duodénal ou un infiltrat périduodénal sténosant. En conclusion, l’EED peut être considérée comme un examen utile dans la pancréatite aiguë lorsque l’imagerie conventionnelle n’est pas diagnostique.

Summary

The diagnosis of acute pancreatitis relies mainly upon clinical and biological signs. Imaging and complementary investigations are often required to confirm the diagnosis, to detect possible etiologies, and to describe potential complications. Although endoscopic ultrasonography (EUS) has been shown to be useful in the diagnosis of various etiologies of acute pancreatitis, very few studies have compared EUS with other imaging procedures in this setting. EUS has been demonstrated to be the most accurate procedure to detect biliary lithiasis and microlithiasis, to diagnose the cause of distal biliary or pancreatic duct obstruction, or to confirm the diagnosis of pancreatitis after non-conclusive conventional imaging. EUS followed by fine needle aspiration (FNA) may also play a role in the differential diagnosis between acute inflammatory conditions and malignant tumors. In severe cases, EUS can be performed on bedside in intensive care units although duodenal or gastric outler obstruction may preclude appropriate endosonographic evaluation. EUS should thus be considered as a valuable tool in acute pancreatitis when conventional imaging failed to provide an accurate diagnosis.

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  1. Gastroenterology Unit, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 1200, Brussels, (Belgium)

    P. H. Deprez

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Deprez, P.H. Reste-t-il une place pour l’échoendoscopie dans le bilan étiologique de la pancréatite aiguë?. Acta Endosc 33, 11–16 (2003). https://doi.org/10.1007/BF03023669

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