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Endoscopic Ultrasonography Reveals Occurrence of Chronic Pancreatitis in Patients with Idiopathic Recurrent Acute Pancreatitis
Reuben Thomas Kurien1, Deepu David1, Kattiparambil Gangadharan Sajith1, Anjilivelil Joseph Joseph1, Sudipta Dhar Chowdhury1, Ebby George Simon1, Bharath Kumar Chandrashekaraiah1, Bharath Kumar Ayapati1, Rajeev SA1, Kaushik Chatterjee1, Ashok Chacko2, Amit Kumar Dutta1
1Department of GI Sciences, Christian Medical College and Hospital, Vellore-632004, India
2Institute of Gastroenterology and Liver Disease, The Madras Medical Mission-600037, Chennai , India

Corresponding Author
Dr. Deepu David


Background: Chronic pancreatitis develops in a subgroup of patients with recurrent acute pancreatitis. Detection of chronicity helps prognostication and formulation of management plan. Endoscopic ultrasonography (EUS) may detect early stages of chronic pancreatitis and hence serve as a useful diagnostic tool. 
Aim: To assess the frequency of chronic pancreatitis in patients with idiopathic recurrent acute pancreatitis (IRAP) using EUS. 
Methods: Patients with diagnosis of IRAP over a ten year period were retrospectively included. The clinical and investigation details were recorded on a structured proforma. Details of findings on EUS were recorded and proportion of patients with chronic pancreatitis was estimated. Presence of calcification and eight other parenchymal/ductal features were assessed during EUS. Presence of calcification or five of the other eight features were required for the diagnosis of chronic pancreatitis. 
Results: 154 patients with IRAP were included in the study. Their mean age was 31.2 + 12.5years and 77.9% were male. Thirtyeight (24.7%) patients had definitive features of chronic pancreatitis on EUS. Another 54 (35.1%) patients with 3 or 4 criteria present were considered to have intermediate probability of chronic pancreatitis. Calcification was present in 19 patients which was not detected on transabdominal imaging (ultrasound or CT). Twenty-two patients had diabetes mellitus. 
Conclusion: EUS detected features of chronic pancreatitis in a quarter of patients with IRAP. Hence EUS may play an important role in management of these patients.