Predicting post‐endoscopic retrograde cholangiopancreatography pancreatitis using the 4‐h serum lipase level. Issue 1 (25th July 2016)

• Record Type: Journal Article
• Authors: Papachristos, Alexander; Howard, Tess; Thomson, Benjamin N.; Thomas, Peter R.
• Is Part Of: ANZ journal of surgery. Volume 88:Issue 1/2(2018)
• Page Start: 82
• Page End: 86
• Publication Date: 2016-07-25
• Subjects: amylase -- ERCP -- lipase -- pancreatitis -- rural health; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.13665
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract : 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.