Medline ® Abstract for Reference 56
of 'Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis'
Predicting post-endoscopic retrograde cholangiopancreatography pancreatitis using the 4-h serum lipase level.
Papachristos A, Howard T, Thomson BN, Thomas PR
ANZ J Surg. 2016;
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.
Department of Surgery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.