Stuart Sherman

Unexplained Acute Pancreatitis and Acute Recurrent Pancreatitis

Abstract Idiopathic acute pancreatitis (IAP) and idiopathic acute recurrent pancreatitis (IARP) are commonly encountered, though less commonly understood, clinical entities. There are two major concerns that prompt physicians to do a more intensive evaluation of the patient with IAP or IARP. The first is that the patient may have an underlying disease that will predispose to further attacks of IAP. The second concern is that the pancreatitis may be related to a tumor. This chapter reviews the role of EUS, MRCP, and ERCP in the evaluation and therapy of patients with IAP or IARP. The reader should be aware that controversy exists as to the appropriate use and timing of ERCP in IAP and IARP because the available evidence is often sparse and largely uncontrolled. A recommended algorithm for the work-up of patients with IAP and IARP will be presented at the end of this chapter.

Cholangiography and Pancreatography

Abstract Endoscopic retrograde cholangiopancreatography (ERCP) is no longer the first choice for diagnostic imaging for many conditions of the biliary tree and pancreas, due to relative risk for complications compared to current noninvasive modalities. However, ERCP remains a firmly established therapeutic modality that offers a wide range of interventions for pancreaticobiliary disease. Skillful execution of diagnostic ERCP remains crucial for the safe and effective deployment of endoscopic therapies. The pancreaticobiliary endoscopist must also master the interpretation of normal and pathologic radiographic findings encountered during ERCP to ensure the highest quality of care for patients. We present an evidence-based review of techniques for safe and efficient diagnostic ERCP. We also review radiographic features of a normal cholangiogram and pancreatogram, as well as findings associated with frequently encountered pathologies of the pancreas and biliary tree.