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Medline ® Abstract for Reference 21

of 'Endoscopic retrograde cholangiopancreatography: Indications, patient preparation, and complications'

Early recognition of post-ERCP pancreatitis by clinical assessment and serum pancreatic enzymes.
Gottlieb K, Sherman S, Pezzi J, Esber E, Lehman GA
Am J Gastroenterol. 1996;91(8):1553.
BACKGROUND: This study evaluates the relative value of clinical assessment and serum pancreatic enzymes in the discharge management of outpatients undergoing ERCP.
METHODS: Two hundred thirty-one patients who underwent ERCP had a detailed clinical assessment performed 2 h after the procedure and blood drawn for amylase and lipase.
RESULTS: One-third of the patients who later developed pancreatitis had no pain 2 h after the end of the procedure, whereas an equal number who had no pancreatitis did complain of pain. Values below 276 U/L for amylase and 1000 U/L for lipase were useful in ruling out pancreatitis with negative predictive values of 0.97 and 0.98, respectively. Based on the data of this study a discharge algorithm for outpatients undergoing ERCP is proposed.
CONCLUSIONS: In contrast to clinical assessment, which is unreliable, it is possible to stratify patients according to their risk of developing pancreatitis according to their 2-h serum amylase and lipase values. This helps to rationalize the discharge management ofoutpatients undergoing ERCP at a time when careful utilization of resources, especially the avoidance of unnecessary hospital admissions, becomes increasingly more important.
Indiana University Medical Center, Indianapolis, USA.