Role of duodenal bile crystal analysis in idiopathic pancreatitis

The aim of this study was to find out the incidence and clinical use of duodenal bile crystal analysis in patients presenting with idiopathic pancreatitis.

Sixty consecutive patients with acute pancreatitis were studied. They were divided into two subgroups (known and unknown causes). Sixty patients were used as controls and divided into 3 subgroups (n = 20 each). The patients of acute pancreatitis with severe or life threatening complications or those requiring surgical interventions were excluded. Bile samples from both groups were analyzed for presence or absence of crystals.

The maximum age incidence of acute pancreatitis was in the fifth decade (41-50 years). The M/F ratio was 3.6:1. Recurrent acute pancreatitis was observed in 26.6% cases (20% idiopathic vs. 6.6% known aetiology). Twenty-five percent of the control sub group (n = 20) cases of cholelithiasis without history of pancreatitis had positive microcrystals in their bile sample. In patients with idiopathic pancreatitis (n = 18), 7 cases (11.6%) had crystals in the bile. In those with known causes of pancreatitis (n = 42), 33 cases (55%) had positive crystals in the bile.

Thirty percent of our patients had idiopathic acute pancreatitis with a high rate of clinical recurrence (20%). Duodenal bile crystal analysis detected 7 cases of microlithiasis out of 18 cases in this group and suggested an aetiology. This procedure should be used more often.