Predicting post-endoscopic retrograde cholangiopancreatography pancreatitis using the 4-h serum lipase level.
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) is a complex therapeutic procedure that is complicated by pancreatitis in 3-5% of cases. The aim of this study is to determine whether a 4-h post-ERCP serum lipase level is superior to the serum amylase level in predicting the occurrence of post-ERCP pancreatitis (PEP).


METHODS
We performed a retrospective review of prospectively collected data on 543 consecutive patients undergoing therapeutic ERCP at a single centre. Serum lipase and amylase levels were measured at 4-h post-procedure and were recorded as a factor of the upper limit of normal: amylase factor (AF) and lipase factor (LF). Sensitivity and specificity were compared using receiver-operating characteristics and the Youden index (YI).


RESULTS
A total of 506 procedures were considered for analysis. PEP occurred in 19 patients (3.8%). A LF of <10 was useful for the exclusion of PEP with a sensitivity of 100% and a specificity of 94%, YI = 0.94. In contrast, an AF <3 yielded a sensitivity of 79% and specificity of 94%, YI = 0.73.


CONCLUSION
Serum lipase measured at 4-h post-ERCP better excludes PEP than serum amylase measured at the same time point. Patients with a LF <10 may be safely considered for same-day discharge.
['Papachristos|Alexander|A|', 'Howard|Tess|T|', 'Thomson|Benjamin N|BN|', 'Thomas|Peter R|PR|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000681:Amylases D001660:Biliary Tract Diseases D002760:Cholangiopancreatography, Endoscopic Retrograde D005260:Female D006801:Humans D008049:Lipase D008297:Male D008875:Middle Aged D010195:Pancreatitis D011183:Postoperative Complications D012189:Retrospective Studies D012680:Sensitivity and Specificity D013997:Time Factors D055815:Young Adult
pancreatitis lipase ERCP amylase rural health