Acute pancreatitis is an inflammatory condition with multiple causes, which can be classified as biliary, metabolic, toxic, infectious, or traumatic. Its diagnosis is based on a combination of clinical, biological, and imaging data, aimed at determining its etiology and guiding treatment. In this context, endoscopic ultrasound offers superior resolution compared to other imaging techniques and allows for detailed exploration of pancreatic and biliary structures. 

The aim of this study is to highlight the role and contributions of endoscopic ultrasound in the diagnosis of acute pancreatitis.

This is a retrospective descriptive study conducted in the endoscopy unit of the Hepatology and Gastroenterology Department over a period of 43 months (January 2022 to August 2025). It includes all patients who were hospitalized for AP and underwent EUS.

The data collected include age, gender, medical history, stage of pancreatitis on CT scan, and etiologies revealed by EUS

The data collected included age, sex, medical history, stage of pancreatitis on CT scan, and etiologies revealed by EUS.

During the study period, 124 patients were hospitalized in our department for

acute pancreatitis. In 24 patients (19%), the initial etiological assessment did not reveal any obvious cause.

The average age of this population was 49.4 years (19-73). The sex ratio was 1.3 (13 women to 10 men). The medical history noted was diabetes in 5 patients (4%), cholecystectomy in 2 patients (1.7%), and Caroli's disease in one patient (0.8%).

Four patients (3.2%) had recurrent pancreatitis. The stage of AP was stage A in 3 cases (13.04%), stage B in 7 cases (30.43%), stage C in 5 cases (21.7%), and stage E in 8 cases (34.8%).

Echoendoscopy revealed a lithiasic origin in 16 cases (12.9%), autoimmune pancreatitis in 3 cases (2.4%), and a mass in the head of the pancreas in 3 patients (2.4%), with histology confirming pancreatic adenocarcinoma in one patient and autoimmune pancreatitis in its pseudotumoral form in the other patient, pancreas divisum in one patient (0.8%), and TIPMP in one patient (0.8%). In 4

patients (3.22%), echoendoscopy revealed no abnormalities.

Among the four patients who presented with recurrent pancreatitis, endoscopic ultrasound revealed a heterogeneous appearance with diffuse calcifications in two of them, thus revealing

chronic calcifying pancreatitis.

In light of our study, echoendoscopy has established itself as an essential diagnostic modality in the evaluation of acute pancreatitis, particularly for identifying underlying causes such as microlithiasis or unrecognized biliary abnormalities, diagnosing chronic pancreatitis and autoimmune AP, determining the benign or malignant nature of pancreatic masses through histology, and detecting pancreatic malformations.

benign or malignant nature of pancreatic masses, and to detect pancreatic malformations.

 Its high resolution and ability to combine morphological exploration and interventional procedures make it a tool of choice in an integrated diagnostic and therapeutic approach. However, its use must be carefully considered and reserved for appropriate indications, as part of an optimized multidisciplinary management approach.