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Background and study aims The etiology of idiopathic acute pancreatitis (IAP) should always be defined. Our aim was to compare the diagnostic value of endoscopic ultrasound (EUS) versus secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) in patients with IAP. Patients and Methods Patients admitted to a single tertiary care University hospital with IAP were invited to participate in the study. Enrolled patients underwent EUS and S-MRCP in a single-blinded comparative study. EUS and S-MRCP were performed no sooner than 4 weeks after discharge. The diagnostic yield of EUS and S-MRCP and demographic variables were included in the analysis. Additional follow-up, results of subsequent serology, radiographic exams, and relevant histological analysis were considered in determination of the final diagnosis. Results A total of 34 patients were enrolled; EUS was normal in six, cholelithiasis was defined in 15, choledocholithiasis in two, pancreas divisum in three, branch-type intraductal papillary mucinous tumor (IPMT) in three, and chronic pancreatitis in five. S-MRCP identified choledocholithiasis in one, divisum in four, branch-type IPMT in three, chronic pancreatitis in two; 24 subjects diagnosed as normal by S-MRCP. Diagnostic correlation between EUS and S-MRCP was slight (kappaâ=â0.236, 95â% confidence interval: 0.055-0.416). EUS provided a statistically significantly higher diagnostic yield than S-MRCP: 79.4â% (CI95â%: 65â%-94â%) vs 29.4â% (CI95â%: 13â%-46â%) (Pâ=â0.0002). The sensitivity, specificity, and positive and negative predictive values of EUS and S-MRCP were 90â%, 80â%, 96â%, 57â% and 33â%, 100â%, 100â% and 16â%, respectively. Conclusion The diagnostic yield of EUS is higher than S-MRCP in patients with IAP.
RESUMO
El objetivo del trabajo consistió en analizar las correlaciones entre: cociente Proteína/Creatinina en la primera orina de la mañana y Proteinuria de 24 horas (P/C-P24h); y cociente Albúmina/Creatinina en la primera orina de la mañana y Albuminuria de 24 horas (A/C-A24h) en pacientes con Lupus Eritematoso Sistémico y también evaluar la influencia del Clearance de Creatinina (ClCr) sobre la correlación P/C-P24h. Fue un estudio observacional, transversal y prospectivo. Se estudiaron 80 muestras de 52 pacientes lúpicos ambulatorios, entre marzo de 2013 y agosto de 2014. Se evaluaron mediante coeficiente de correlación de Spearman (CCS), las correlaciones P/C-P24h y A/C-A24h en distintos rangos de proteinuria y la influencia del ClCr sobre P/C-P24h. Para P/C-P24h cuando P24h<300 mg/24h CCS=0,6169 (n=52); cuando P24h≥300 mg/ 24h CCS=0,7461 (n=28). Para P/C-P24h en pacientes con ClCr<60 mL/ min CCS=0,9016 (n=12), y con ClCr>60 mL/min CCS=0,8689 (n=66). Para A/C-A24h a P24h<300 mg/24h CCS=0,8082 (n=37). Todos con p<0,0001. Este estudio mostró buena correlación P/C-P24h para P24h≥300 mg/24h y A/C-A24h para P24h<300 mg/24h. No se observó influencia del ClCr en la correlación P/C-P24h. Estos resultados sumados a los obtenidos por otros autores apoyan el uso del cociente A/C a P24h<300 mg/24h y P/C a P24h≥300 mg/24h para el seguimiento del compromiso renal en pacientes con Lupus Eritematoso Sistémico utilizando la primera orina de la mañana.
The objective of the present work was to analyze the correlation between: protein/creatinine ratio in first-morning urine and 24-hour urine protein (P/C-P24h), and albumin/creatinine ratio in first-morning urine and 24-hour urine albumin (A/C-A24h) in patients with Systemic Lupus Erythematosus, and to evaluate the influence of creatinine clearance (CrCl) on the P/C-P24h correlation.It was a prospective cross-sectional study in which 80 samples of 52 outpatients with lupus were studied between March 2013 and August 2014. They were evaluated by Spearman Correlation Coefficient (CCS), the P/C-P24h and A/C-A24h correlations in different ranges of proteinuria and the influence of ClCr on P/C-P24h.This study showed a good correlation P/C-P24h for P24h≥300 mg/24h and A/C-A24h for P24h<300 mg/24h. No influence of ClCr in the P/C-P24h correlation was observed. These results and those obtained by other authors support the use of the A/C to P24h<300 mg/24h ratio and P/C to P24h≥300 mg/24h ratio to monitor renal involvement in patients with systemic lupus erythematosus using the first-morning urine.
O objetivo do trabalho foi analisar as correlações entre quociente Proteína/Creatinina na primeira urina da manhã e Proteinúria de 24 horas (P/C-P24h); e quociente Albumina/Creatinina na primeira urina da manhã e Albuminuria de 24 horas (A/C-A24h) em paciêntes com Lupus Eritematoso Sistêmico e também avaliar a influência do Clearance de Creatinina (ClCr) sobre a correlação P/C-P24h. Foi um estudo observacional transversal e prospectivo. Foram estudadas 80 amostras de 52 pacientes ambulatórios com lúpus, entre março de 2013 e agosto de 2014. Avaliaram-se através do coeficiente de correlação de Spearman (CCS), as correlações P/C-P24h e A/C-A24h em diferentes níveis de proteinúria e a influência do ClCr sob P/C-P24h. Para P/C-P24h quando P24h<300 mg/24h CCS=0,6169 (n=52); quando P24h≥300 mg/24h CCS=0,7461 (n=28). Para P/C-P24h em pacientes com ClCr<60 mL/min CCS=0,9016 (n=12), e com ClCr>60mL/min CCS=0,8689 (n=66). Para A/C-A24h a P24h<300 mg/24h CCS=0,8082 (n=37). Em todos os casos, p<0,0001. Este estudo mostrou boa correlação P/C-P24h para P24h≥300 mg/24h y A/C-A24h para P24h<300 mg/24h. Não foi observada influência do ClCr na correlação P/C-P24h. Estes resultados, somados aos obtidos por outros autores, apoiam o uso do quociente A/C a P24h<300 mg/24h e P/C a P24h≥300 mg/24h para o seguimento do compromisso renal em pacientes com Lúpus Eritematoso Sistêmico utilizando a primeira urina da manhã.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Albuminúria , Creatinina/urina , Lúpus Eritematoso Sistêmico , Albuminas , Creatinina , UrinaRESUMO
AIM: To discuss the feasibility of single session endoscopic ultrasonography (EUS) to discuss and endoscopic retrograde cholangiopancreatography (ERCP) execution. METHODS: Retrospective endoscopic and anesthetic outcome comparison of performing both EUS and ERCP in a single endoscopic session (Group I) versus performing each procedure in two different sessions (Group II) was made. The following variables were evaluated: epidemiological variables, American Society of Anesthesiologists Physical Status Classification (ASA) level, procedural time, propofol dose, anesthetic complications, endoscopic complications and diagnostic yield, and therapeutic procedures on both groups. T-student, Chi-Square and Fisher test were used for comparison. RESULTS: We included 39 patients in Group I (mean age: 69.85 ± 9.25; 27 men) and 46 in Group II (mean age: 67.46 ± 12.57; 25 men). Procedural time did not differ significantly between both groups (Group Ivs Group II: 93 ± 32.78 vs 98.98 ± 38.17; P >0.05) but the dose of propofol differed (Group I vs Group II: 322.28 ± 250.54 mg vs 516.96 ± 289.06 mg; P = 0.001). Three patients had normal findings on both explorations. Three anesthetic complications [O(2) desaturation (2), broncoaspiration (1)] and 9 endoscopic complications [pancreatitis (6), bleeding (1), perforation (1), cholangitis (1)] occurred without significant differences between both groups (P > 0.05). We did not find any significant difference regarding age, sex, ASA scale level, diagnostic yield or therapeutic maneuvers between both groups. CONCLUSION: The performance of EUS and ERCP in a single session offers a similar diagnostic and therapeutic yield, does not entail a higher complication risk and requires a significantly smaller dose of propofol for sedation compared with performing each exploration in a different session.
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Endoscopic ultrasonography has become an important diagnostic and therapeutic tool in endoscopy units. It has a great impact on biliary and pancreatic disease management and its application to retrograde cholangiopancreatography is appealing, although very challenging with current devices. In this article we describe our initial experience with this technique.