The yield of endoscopic ultrasonography (EUS) in abdominal pain of unclear etiology

Aim: To determine the yield of EUS in patients with chronic abdominal pain of unclear etiology. Methods: From our EUS database of over 550 EUS examinations performed from 12192-12195, 15 patients (4 males, 11 females, mean age: 52 yrs.) were selected in which the primary indication for examination was abdominal pain of unclear etiology. The diagnostic yield of EUS in this group of patients was analyzed. Inclusion criteria: 1. Referring physician judged the patient to have organic disease and a complete evaluation by standard imaging tests was unrevealing. 2. Workup in all patients included a negative EGD and CT. 3. Duration of upper abdominal pain of more than 3 months. Exclusion criteria: history of chronic pancreatitis, acute pancreatitis or cholecystectomy within the preceding 2 years, pancreas divisum, jaundice, gallstone disease, irritable bowel syndrome, inflammatory bowel disease, alcohol abuse and any significant abnormality detected on prior studies with the exception of sphincter of Oddi dysfunction (type 31 with continued pain after sphincterotomy. Results: EUS detected pancreatic parenchymal abnormalities in 4 (27%) patients: 1. pancreatic malignancy 2. changes suspicious for chronic pancreatitis (pancreatic cancer found at surgery) 3. questionable pancreatic mass (chronic pancreatitis found at surgery) 4. changes consistent with chronic pancreatitis. Papillary stenosis was diagnosed in one patient with common bile duct dilation detected. EUS was normal in 10 (67%) of patients. Follow-up of these 10 patients reveals: 7 persistent abdominal pain (mean follow-up: 9 mos.; range 4-13 mos.), 1 chronic cholecystitis, 1 pancreatic cancer (diagnosed 5 mos. after EUS examination), 1 irritable bowel syndrome. Conclusions: 1. EUS may detect significant abnormalities in a small subset of patients with chronic, unexplained abdominal pain. 2. Although the yield is low, EUS should be considered in patients with persistent pain and a high-index of clinical suspicion for possible pancreatic pathology. 3. These preliminary data indicate a need for further studies to refine the role of EUS in abdominal pain of unclear etiology.