P4365 - Endoscopic Ultrasound (EUS) vs Magnetic Resonance Cholangiopancreatography (MRCP) in the Etiologic Evaluation of Idiopathic Acute Pancreatitis: A Systematic Review and Meta Analysis

Award: ACG Presidential Poster Award

Jahnavi Udaikumar, MD¹, Rithish Nimmagadda, MBBS², Vineeth Potluri, MD³, Ravi Medarametla, MD⁴, Sameer Garlapati, MD⁵, Nayanika Tummala, MD⁶, Vindhya Vasini Lella, MBBS⁷, Adam Goodman, MD⁸, Daniel Marino, MD, MBA⁹
1NYU Grossman School of Medicine, Department of Medicine, New York, NY; 2One Brooklyn Health-Interfaith Medical Center, Brooklyn, NY; 3Cleveland Clinic, Cleveland, OH; 4Mamata Medical College, Khammam, Telangana, India; 5Howard University Hospital, Washington, DC; 6St. Mary's General Hospital, New York Medical College, Poughkeepsie, NY; 7Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India; 8NYU Grossman School of Medicine, Division of Gastroenterology and Hepatology, New York, NY; 9NYU Langone Health, New York, NY

Introduction: Idiopathic acute pancreatitis (IAP) accounts for up to 20% of cases despite comprehensive initial evaluation. Determining the etiology is crucial to guide management and prevent progression to chronic pancreatitis (CP). Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are second-line imaging modalities, although their relative diagnostic performance remains unclear. This systematic review and meta-analysis compares the diagnostic yield of EUS and MRCP in identifying underlying causes of IAP.

Methods: A systematic search of PubMed, EMBASE, and Google Scholar (January 2000–April 2025) identified English-language studies comparing EUS and MRCP diagnostic performance in IAP. Two reviewers independently extracted data and assessed study quality using the Newcastle-Ottawa Scale. Pooled relative risks (RR) were calculated using a random-effects model, with subgroup, sensitivity, and publication bias analyses done per PRISMA 2020. Subgroup analyses assessed diagnostic yield by etiology—biliary disease (cholelithiasis, choledocholithiasis, microlithiasis, and sludge), pancreatic divisum, and malignancy (pancreatic adenocarcinoma and periampullary cancer).

Results: Of 4,933 studies screened, 8 met inclusion criteria. Pooled analysis showed EUS had significantly higher diagnostic yield than MRCP (RR = 2.01; 95% CI: 1.42–2.85; p < 0.01; I² = 69.1%) (Figure 1). EUS was markedly superior for biliary etiologies (RR = 3.67; 95% CI: 2.08–6.47; p < 0.0001; I² = 37.7%) (Figure 2) and trended toward better detection of CP in IAP (RR = 2.20; 95% CI: 0.87–5.55; p = 0.0955; I² = 15.5%) (Figure 3). MRCP favored detection of pancreatic divisum (RR = 0.59; 95% CI: 0.31–1.12; p = 0.1078; I² = 0.0%) (Figure 4). EUS also demonstrated higher cancer detection compared to MRCP (RR = 1.98; 95% CI: 0.56–7.03; p = 0.2896; I² = 0.0%) (Figure 5).

Discussion: EUS surpasses MRCP in diagnosing IAP biliary etiologies and had an overall higher diagnostic yield. Prior studies suggest that EUS may be oversensitive in diagnosing CP, which may be consistent with the increased rate of diagnosis by EUS in our data. There was some signal that EUS had a higher diagnostic yield for cancer which may highlight a potential role in identifying occult malignancy in IAP evaluation. In practice, choosing EUS vs. MRCP depends on resource availability, but a patient-centered approach that integrates modality strengths with clinical profiles can improve diagnostic accuracy and prognostic outcomes.


Figure: Figure 1: Overall Diagnostic Yield of EUS vs MRCP in IAP
Figure 2: EUS vs MRCP for Biliary Etiologies of IAP


Figure: Figure 3: EUS vs MRCP for Chronic Pancreatitis in IAP
Figure 4: EUS vs MRCP for Pancreatic Divisum Etiology of IAP
Figure 5: EUS vs MRCP for Cancer Etiology of IAP

Disclosures:
Jahnavi Udaikumar indicated no relevant financial relationships.
Rithish Nimmagadda indicated no relevant financial relationships.
Vineeth Potluri indicated no relevant financial relationships.
Ravi Medarametla indicated no relevant financial relationships.
Sameer Garlapati indicated no relevant financial relationships.
Nayanika Tummala indicated no relevant financial relationships.
Vindhya Vasini Lella indicated no relevant financial relationships.
Adam Goodman: Ambu, Inc – Advisor or Review Panel Member. Boston Scientific – Advisor or Review Panel Member. Iterative Health – Advisor or Review Panel Member.
Daniel Marino indicated no relevant financial relationships.

Jahnavi Udaikumar, MD¹, Rithish Nimmagadda, MBBS², Vineeth Potluri, MD³, Ravi Medarametla, MD⁴, Sameer Garlapati, MD⁵, Nayanika Tummala, MD⁶, Vindhya Vasini Lella, MBBS⁷, Adam Goodman, MD⁸, Daniel Marino, MD, MBA⁹. P4365 - Endoscopic Ultrasound (EUS) vs Magnetic Resonance Cholangiopancreatography (MRCP) in the Etiologic Evaluation of Idiopathic Acute Pancreatitis: A Systematic Review and Meta Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.