Endosonography and magnetic resonance cholangiopancreatography show similar efficacy in selecting patients for ERCP in mild-moderate acute biliary pancreatitis

WOS: 000311871900023PubMed ID: 23161305Background/aims: We aimed to compare the value of endoscopic ultrasonography and magnetic resonance cholangiopancreatography in identifying the patients with mild-moderate acute biliary pancreatitis who require endoscopic retrograde cholangiopancreatography. Material and Methods: The study was prospectively conducted in a tertiary hospital between June 2006 and October 2009. Ninety-five patients without urgent endoscopic retrograde cholangiopancreatography requirement and with mild-moderate acute biliary pancreatitis were included in the study. Patients whose amylase, C-reactive protein, and bilirubin levels had decreased more than 50% on the fifth day compared to admission levels were randomized to magnetic resonance cholangiopancreatography or endoscopic ultrasonography, and the common bile duct was evaluated. Endoscopic retrograde cholangiopancreatography was performed in patients with stone detected with endoscopic ultrasonography or magnetic resonance cholangiopancreatography. With regard to the presence of common bile duct stone in endoscopic retrograde cholangiopancreatography, endoscopic retrograde cholangiopancreatography performances were classified as therapeutic or diagnostic. Results: Endoscopic retrograde cholangiopancreatography was performed in 16 of the 48 patients (33.3%) in the endoscopic ultrasonography group and in 18 of the 47 patients (38%) in the magnetic resonance cholangiopancreatography group. Therapeutic endoscopic retrograde cholangiopancreatography was performed in 14/16 patients (87%) in the endoscopic ultrasonography group and in 16/18 patients (88%) in the magnetic resonance cholangiopancreatography group. The ratio of total number of endoscopic retrograde cholangiopancreatographis was not significantly lower in the endoscopic ultrasonography (16/48) than in the magnetic resonance cholangiopancreatography (18147) group, and the ratio of therapeutic endoscopic retrograde cholangiopancreatographis (14/16) was not higher in the endoscopic ultrasonography group than in the magnetic resonance cholangiopancreatography group (16/18). Conclusions: The necessity of therapeutic endoscopic retrograde cholangiopancreatography was determined with similar efficacy by endoscopic ultrasonography and magnetic resonance cholangiopancreatography in mild-moderate acute biliary pancreatitis

Etiological role of brucellosis in autoimmune hepatitis

To show that brucellosis may trigger autoimmune hepatitis (AIH), in addition to nonspecific liver involvement and toxic hepatitis, due to a class effect of tetracycline family used for treatment. We present a female patient admitted to our hospital due to partially improved fatigue and elevated liver enzymes following doxycycline and streptomycin usage for brucellosis. Brucellosis is endemic in our country, Turkey. It may involve any organ in the body. Liver is frequently involved. Doxycycline used for treatment occasionally may lead to hepatotoxicity. AIH is a necroinflammatory disease of the liver. Certain drugs (e.g. minocycline), toxins, and viruses (hepatitis B, hepatitis C, EBV, etc.) can trigger AIH. Only one case of AIH probably caused by doxycycline and brucellosis was reported. We discuss the relationship between brucellosis, AIH, and hepatotoxicity of doxycycline. Brucellosis may trigger AIH. (C) 2005 The WJG Press and Elsevier Inc. All rights reserved