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Hirota M, Itoi T, Morizane T, Koiwai A, Yasuda I, Ryozawa S, Mukai S, Ikeura T, Irisawa A, Iwasaki E, Katanuma A, Kitamura K, Takenaka M, Ito T, Masamune A, Mayumi T, Takeyama Y. Postprocedure serum amylase or lipase levels predict postendoscopic retrograde cholangiopancreatography pancreatitis: Meta-analysis of diagnostic test accuracy studies and utility assessment. Dig Endosc 2024; 36:670-687. [PMID: 37921041 DOI: 10.1111/den.14718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/30/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES We aimed to clarify the clinical utility of measuring serum pancreatic enzymes after endoscopic retrograde cholangiopancreatography (ERCP) for the purpose of predicting post-ERCP pancreatitis (PEP) by a meta-analysis of diagnostic test accuracy studies. METHODS Studies on the prediction accuracy of PEP by serum amylase or lipase measured at 2, 3, and 4 h after ERCP were collected. A literature search was performed in PubMed and the Cochrane Library database for studies published between January 1980 and March 2023. The quality of individual studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2. Data were analyzed using Meta-DiSc 2.0 software. RESULTS We searched the databases and identified 20 observational studies (12,313 participants). PEPs were defined according to criteria by Cotton or modified Cotton, revised Atlanta criteria, or the Japanese criteria. Meta-analysis of eight studies (4389 participants) showed a pooled sensitivity of 71.1% (95% confidence interval [CI] 56.1-82.5) and pooled specificity of 91.2% (95% CI 85.9-94.6) for the serum amylase cut-off value at 3 times the upper limit of normal (ULN). Another meta-analysis of five studies (1970 participants) showed a pooled sensitivity of 85.8% (95% CI 61.9-95.7) and pooled specificity of 85.3% (95% CI 81.9-88.1) for the serum lipase cut-off value at 3 times ULN. CONCLUSION Despite a high risk of bias due to various reference standards, this updated meta-analysis and the utility assessment by a decision tree showed the utility of serum amylase or lipase levels more than 3 times ULN measured 2-4 h after ERCP for predicting PEP.
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Affiliation(s)
- Morihisa Hirota
- Division of Gastroentrology, Tohoku Medical and Pharmaceutical University, Miyagi, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Toshio Morizane
- Center of Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kanagawa, Japan
| | - Akinobu Koiwai
- Division of Gastroentrology, Tohoku Medical and Pharmaceutical University, Miyagi, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Tsukasa Ikeura
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Eisuke Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Katsuya Kitamura
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tetsuhide Ito
- Neuroendocrine Tumor Centre, Fukuoka Sanno Hospital, International University of Health and Welfare, Fukuoka, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Toshihiko Mayumi
- Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Aichi, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
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Samanta A, Vadlapudi SS, Srivastava A, Mohindra S, Sen Sarma M, Poddar U, Saraswat VA, Mishra P. Risk Factors for Post-Endoscopic Retrograde Cholangio-Pancreatography Pancreatitis in Children With Chronic Pancreatitis and Its Prediction Using 4-Hour Postprocedure Serum Amylase and Lipase Levels. Pancreas 2024; 53:e247-e253. [PMID: 38227737 DOI: 10.1097/mpa.0000000000002296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP) is seen in 3% to 16% of children undergoing therapeutic endoscopic retrograde cholangio-pancreatography (ERCP). We evaluated the risk factors of PEP and utility of 4-hour post-ERCP amylase and lipase for early prediction of PEP in children with chronic pancreatitis (CP). MATERIALS AND METHODS Thirty children with CP (boys 20, 14.3 [interquartile range, 9.3-16] years) who underwent 62 ERCP procedures were studied. Clinical and procedural details with outcome were noted. Serum amylase and lipase were measured before, 4 hours, and 24 hours after ERCP. Multivariate analysis was done to identify risk factors for PEP. Cutoff scores of 4-hour amylase and lipase were identified. RESULTS PEP occurred in 14.5% (9/62) of ERCP procedures (mild, 8; moderate, 1) with no mortality. On univariate analysis, endoscopic sphincterotomy ( P = 0.04), difficult cannulation ( P = 0.004), and prior PEP ( P = 0.036) were risk factors, while prior ERCP ( P = 0.04) was protective. Difficult cannulation (odds ratio, 5.83; 95% confidence interval, 1.329-25.592) was the independent risk factor on multivariate analysis overall and for first ERCP session alone. Amylase >3.3 times upper limit of normal (ULN) and lipase of >5 times ULN at 4 hours had best sensitivity and specificity for diagnosis of PEP. All cases with PEP were symptomatic by 6 hours and none had amylase/lipase <3 ULN at 4 hours. Amylase/lipase of <3 ULN at 4 hours could exclude PEP with good sensitivity (100%) and specificity (76% and 81%, respectively). CONCLUSIONS PEP occurred in 14.5% of procedures in children with CP, with difficult cannulation being the independent risk factor. Asymptomatic patients with 4-hour amylase/lipase <3 times ULN can be safely discharged.
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Affiliation(s)
| | | | | | | | | | - Ujjal Poddar
- From the Departments of Pediatric Gastroenterology
| | | | - Prabhakar Mishra
- Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Parvin S, Islam MS, Majumdar TK, Azam MG, Islam MS, Begum MR, Hossain MA, Imam I, Ahmed F. Post-ERCP pancreatitis: Frequency and risk stratification from four tertiary care referral hospitals in South East Asia. Medicine (Baltimore) 2022; 101:e30216. [PMID: 36042621 PMCID: PMC9410617 DOI: 10.1097/md.0000000000030271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a dreaded complication. But the frequency of this complication varies widely (1%-40%) among the literature and across geographical regions. With uncertainty in the estimation of occurrence and having no accepted, safe, effective method to prevent it, identification of its frequency and predictable risk factors is very crucial in a local or regional setting. The aim of this study was to identify the frequency of PEP and its risk factors from 4 tertiary care referral centers from a country in the South East Asia Region. This cross-sectional study was done on 1042 consecutive ERCP in adult patients (age >18 years) with baseline serum amylase levels less than 3 times the upper level of standard value. On the basis of clinical features and the amylase level at 24 hours (the next morning), the procedure was evaluated to confirm PEP. The frequency of PEP was calculated and procedure, patient, or operator-related independent risk factors for occurring PEP were analyzed using univariate and multivariate analyses. The study found 204 (19.6%) cases of PEP. In multivariate regression analysis, young age, suspected Sphincter of Oddi Dysfunction, recurrent pancreatitis, needle papillotomy, and pancreatic sphincterotomy were significant risk factors. The univariate analysis also found difficult cannulation and pancreatic duct injection with contrast as significant risk factors. Both patient-related and procedure-related risk factors acted independently for the development of PEP, which occurred in 19.6% of cases. This multicenter assessment of the frequency and risk factors for PEP in our patients would be extremely beneficial for future prevention of this complication.
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Affiliation(s)
- Sultana Parvin
- Department of Medical Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
- *Correspondence: Sultana Parvin, Department of Medical Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Mohakhali, Dhaka 1212, Bangladesh (e-mail: )
| | - Md. Samiul Islam
- National Institute of Traumatology and Orthopedic Rehabilitation, Dhaka, Bangladesh
| | - Touhidul Karim Majumdar
- Department of Medical Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Md. Golam Azam
- Department of Gastrointestinal Hepatobiliary and Pancreatic Disorders, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Mohammad Shohidul Islam
- Department of Medical Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Most. Rokshana Begum
- Department of Hepatology, Shaheed Suhrawardy Medical College and Hospital, Dhak, Bangladesh
| | - Md. Altaf Hossain
- Department of Medical Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
| | - Iftekhar Imam
- Department of Gastrointestinal Hepatobiliary and Pancreatic Disorders, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Faruque Ahmed
- Department of Medical Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
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Goyal H, Sachdeva S, Sherazi SAA, Gupta S, Perisetti A, Ali A, Chandan S, Tharian B, Sharma N, Thosani N. Early prediction of post-ERCP pancreatitis by post-procedure amylase and lipase levels: A systematic review and meta-analysis. Endosc Int Open 2022; 10:E952-E970. [PMID: 35845027 PMCID: PMC9286773 DOI: 10.1055/a-1793-9508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/13/2022] [Indexed: 10/28/2022] Open
Abstract
Background and study aims Post-ERCP pancreatitis (PEP) is the most common complication attributed to the procedure, its incidence being approximately 9.7 %. Numerous studies have evaluated the predictive efficacy of post-procedure serum amylase and lipase levels but with varied procedure-to-test time intervals and cut-off values. The aim of this meta-analysis was to present pooled data from available studies to compare the predictive accuracies of serum amylase and lipase for PEP. Patients and methods A total of 18 studies were identified after a comprehensive search of various databases until June 2021 that reported the use of pancreatic enzymes for PEP. Results The sample size consisted of 11,790 ERCPs, of which PEP occurred in 764 (6.48 %). Subgroups for serum lipase and amylase were created based on the cut-off used for diagnosing PEP, and meta-analysis was done for each subgroup. Results showed that serum lipase more than three to four times the upper limit of normal (ULN) performed within 2 to 4 hours of ERCP had the highest pooled sensitivity (92 %) for PEP. Amylase level more than five to six times the ULN was the most specific serum marker with a pooled specificity of 93 %. Conclusions Our analysis indicates that a lipase level less than three times the ULN within 2 to 4 hours of ERCP can be used as a good predictor to rule out PEP when used as an adjunct to patient clinical presentation. Multicenter randomized controlled trials using lipase and amylase are warranted to further evaluate their PEP predictive accuracy, especially in high-risk patients.
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Affiliation(s)
- Hemant Goyal
- University of Texas at Houston, McGovern School of Medicine, Texas, United States,Mercer University School of Medicine, Internal Medicine, Macon, Georgia, United States
| | - Sonali Sachdeva
- Boston University Medical Center, Medicine, Boston, Masschusetts, United States
| | | | - Shweta Gupta
- John H. Stroger Hospital of Cook County, Medicine, Chicago, Illinois, United States
| | - Abhilash Perisetti
- Parkview Health System, Advanced Interventional Oncology and Surgical Endoscopy, Fort Wayne, Indiana, United States
| | - Aman Ali
- Wilkes-Barre General Hospital, Endoscopy, Wilkes-Barre, Pennsylvania, United States
| | - Saurabh Chandan
- CHI Health Creighton University Medical Center, Gastroenterology & Hepatology, Omaha, Nebraska, United States
| | - Benjamin Tharian
- University of Arkansas for Medical Sciences, Department of Medicin, Division of Gastroenterology & Hepatology, Little Rock, Arkansas, United States
| | - Neil Sharma
- Parkview Health System, Advanced Interventional Oncology and Surgical Endoscopy, Fort Wayne, Indiana, United States
| | - Nirav Thosani
- University of Texas McGovern Medical School, Gastroenterology, Hepatology and Nutrition, Houston, Texas, United States
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Parvin S, Islam MS, Azam MG, Majumdar TK, Ahmed S, Zaman T, Dutta R. Role of 4-H Serum Lipase Level in Predicting Postendoscopic retrograde Cholangiopancreatography Pancreatitis. Int J Appl Basic Med Res 2021; 11:238-242. [PMID: 34912687 PMCID: PMC8633690 DOI: 10.4103/ijabmr.ijabmr_192_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/28/2021] [Accepted: 05/27/2021] [Indexed: 01/23/2023] Open
Abstract
Introduction: Serum amylase level can rise asymptomatically after endoscopic retrograde cholangiopancreatography (ERCP). Thus, its assay can lead to overprediction of post-ERCP pancreatitis (PEP). Lipase assay is used to diagnose other forms of pancreatitis but usually not for PEP. Objectives: The aim of this study was to predict whether lipase may be of better use for the early prediction of PEP. Methods: One hundred and twenty-five consecutive ERCPs performed over a period of 1 year and 9 months were observed. On admission (baseline) and after ERCP at 4 and 24 h, serum amylase and lipase were measured. Based on sensitivity and specificity from the receiver operator characteristic (ROC) curve, optimal cutoff levels for the enzyme, serum lipase, and amylase levels were employed to predict PEP. Results: Out of 125 patients, 26 (20.8%) developed PEP. In multivariate analysis, young age, suspected sphincter of Oddi dysfunction, recurrent pancreatitis, and needle papillotomy were significant risk factors. Considering the optimum cutoff level (single value with the best sensitivity and specificity), both the enzyme amylase and lipase evaluated at 4 h were significant (Chi-square test: P =0.0001 for both the enzymes). However, multivariate regression analysis and levels of enzymes at different cutoff values in the ROC found that 4-h lipase levels were more (about 4 times) increased of the upper limit of normal range than amylase levels (1.19 times). Conclusion: The enzyme, serum amylase, and lipase evaluated at 4 h after ERCP were satisfactory predictors for PEP. However, when compared, serum lipase was more reliable than amylase.
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Affiliation(s)
- Sultana Parvin
- Department of Gastrointestinal Hepatobiliary and Pancreatic Disorders, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Shahbag, Bangladesh.,Department of Medical Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Mohakhali, Bangladesh
| | - Md Samiul Islam
- Department of Orthopaedics, National Institute of Traumatology and Orthopedic Rehabilitation, Shere-Bangla Nagor, Bangladesh
| | - Md Golam Azam
- Department of Gastrointestinal Hepatobiliary and Pancreatic Disorders, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Shahbag, Bangladesh
| | - Touhidul Karim Majumdar
- Department of Medical Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Mohakhali, Bangladesh
| | - Shireen Ahmed
- Department of Gastrointestinal Hepatobiliary and Pancreatic Disorders, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Shahbag, Bangladesh
| | - Taslima Zaman
- Department of Gastroenterology, Japan East West Medical College and Hospital, Dhaka, Bangladesh
| | - Rajib Dutta
- Department of Gastrointestinal Hepatobiliary and Pancreatic Disorders, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Shahbag, Bangladesh
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Analysis of Risk Factors in Endoscopic Retrograde Cholangiopancreatography-Related Immediate and Delayed Hemorrhage. Dig Dis Sci 2021; 66:4467-4474. [PMID: 33469808 DOI: 10.1007/s10620-020-06815-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS Hemorrhage is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP). However, there is a lack of comparative studies on immediate and delayed hemorrhage. The present study aims to explore the relevant risk factors of immediate and delayed hemorrhage of ERCP and compare the similarities and differences. METHODS ERCP cases conducted by our hospital between January 2017 and January 2020 were selected for retrospective analysis. Then age, gender, basic disease, laboratory examinations, and other relevant clinical information were collected for the analysis. RESULTS A total of 1009 ERCP cases were included in the present study. Among these cases, 76 patients were in the immediate hemorrhage group, 28 patients were in the delayed hemorrhage group, and 905 patients were in the non-hemorrhage group. The univariate analysis revealed that choledocholithiasis, pre-cut, and endoscopic papillary sphincterotomy (EST) were risk factors for immediate hemorrhage, while cholangitis, jaundice, coronary heart disease, pre-cut, high postoperative lipase at four hours and amylase at 24 h, high postoperative leukocyte, urea, bilirubin, low postoperative platelet counts and fibrinogen, and prolonged prothrombin time (PT) and thrombin time (TT) were risk factors for delayed hemorrhage. The logistic regression analysis revealed that EST, pre-cut, and activated partial thromboplastin time (APTT) were independent risk factors for immediate hemorrhage, while high amylase at 24 h after ERCP, high postoperative urea, prolonged TT, and coronary heart disease were independent risk factors for delayed hemorrhage. CONCLUSIONS Pre-cut was a common risk factor for immediate and delayed hemorrhage, while other risk factors were different.
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The prognostic value of serum and urine amylase levels and blood count parameters in assessing the risk of post-endoscopic pancreatitis development. GASTROENTEROLOGY REVIEW 2021; 16:132-135. [PMID: 34276840 PMCID: PMC8275959 DOI: 10.5114/pg.2021.106664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022]
Abstract
Introduction Detection of post-endoscopic pancreatitis (PEP) in the first hours after endoscopic retrograde cholangiopancreatography (ERCP) can limit its consequences, while excluding it can provide safe discharge of the patient. Therefore, a simple, clinically available test is needed for this purpose. Aim The assessment of the risk of PEP development based on serum and urine amylase levels and parameters included in blood counts 4 h after ERCP. Material and methods The study included 398 patients after therapeutic ERCP. Four hours after the procedure was completed, serum and urine amylase levels and blood count parameters were analysed. Results The optimal serum amylase level for PEP detection was 516 UI/l, with ACC = 0.94, sens. 77.8%, spec. 0.95; positive predictive value (PPV) 0.412, negative predictive value (NPV) 0.98, positive likelihood factor (LR+) 14.93, and negative likelihood factor (LR-) 0.23. The serum amylase level for exclusion of PEP was 184 UI/l with ACC 0.79, sens. 0.83, spec. 0.79, PPV 0.16, NPV 0.99, and LR- 0.21. The optimal urine amylase level for detection and exclusion (based on Youden index) was 575 UI/l, sens. 83.33%, spec. 81.3%, PPV 0.172, NPV 0.99, LR+ 4.44, and LR- 0.20. Conclusions Serum amylase levels above 516 UI/l at 4 h after ERCP should be an indication for further observation in hospital, and levels below 184 UI/l may justify safe discharge of the patient. Additional determinations of urine amylase levels and parameters included in blood counts do not improve the diagnostic capacity for the detection or exclusion of PEP risk.
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Jaszczuk K, Lipiński M, Rydzewska G. Methods for prevention of acute post-endoscopic retrograde cholangiopancreatography pancreatitis. PRZEGLAD GASTROENTEROLOGICZNY 2020; 15:98-102. [PMID: 32550941 PMCID: PMC7294980 DOI: 10.5114/pg.2020.95555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 11/17/2022]
Abstract
Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP), with incidence rates ranging between 2% and 16%. In addition to being experienced in endoscopic procedures and having knowledge of the patient qualification criteria, physicians should also be aware of the patient and procedure-related risk factors responsible for post-ERCP pancreatitis (PEP). Intrarectal administration of nonsteroidal anti-inflammatory drugs and pancreatic duct stenting were demonstrated to be efficient in high-risk patients. This review provides a broader summary of pharmacological methods and techniques aimed at reducing the risk of PEP.
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Affiliation(s)
- Kamil Jaszczuk
- Department of Internal Medicine and Gastroenterology with IBD Subdivision, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
| | - Michał Lipiński
- Department of Internal Medicine and Gastroenterology with IBD Subdivision, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
| | - Grażyna Rydzewska
- Department of Internal Medicine and Gastroenterology with IBD Subdivision, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
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Lv ZH, Kou DQ, Guo SB. Three-hour post-ERCP amylase level: a useful indicator for early prediction of post-ERCP pancreatitis. BMC Gastroenterol 2020; 20:118. [PMID: 32306904 PMCID: PMC7168821 DOI: 10.1186/s12876-020-01254-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 03/31/2020] [Indexed: 01/17/2023] Open
Abstract
Background To evaluate the value of the 3-h post-ERCP serum amylase level for early prediction of post-ERCP pancreatitis (PEP). Method A study of 206 patients performed ERCP (Encoscopic Retrograde Cholangio-Pancreatography) at a single centre was done from Jan. 2011 to Nov. 2016. The serum amylase or lipase level was measured at 3 h after ERCP. The patients with PEP were recorded. ROC curves were used to statistically analyze the data: The enrolled patients were divided into two groups according to gender, then we analyzed the data respectively. We comprehensively evaluated the predictive value of PEP by 3-h post-ERCP serum amylase level based on the results above. Results Two hundred six patients (92 males, 114 females) were enrolled. PEP occurred in 21 patients (10.19%) among them. The median time to discharge was 7 days (min = 1d, max = 13d) after the procedure. In the 206 patients, the 3-h post-ERCP pancreatic amylase level was used as the test variable, and the PEP occurrence as the state variable to plot the ROC curve. The area under the curve (AUC) was 0.816, and was statistically significant (P < 0.001). The standard error (SE) was 0.0507, the 95% confidence interval (CI) was 0.756–0.866, and the optimal cut-off value was 351 U/L (sensitivity 76.19%, specificity 83.24%, positive likelihood ratio 4.55, negative likelihood ratio 0.29, Youden index 59.43%). Of the 206 patients, there were 83 patients with both 3-h post-ERCP amylase level and lipase level detected, and the ROC curves were plotted for both serum amylase and lipase respectively. The ROC curve matched-pair testing was carried out: The areas under the ROC curves were statistically significant. (P < 0.001) The area under the ROC curve for the 3-h post-ERCP lipase was 0.778, the 95% confidence interval was 0.673–0.862, and optimal cut-off value was 1834 U/L. The area under the ROC curve for the 3-h post-ERCP serum amylase was 0.780, and the 95% confidence interval was 0.676–0.864. The optimal cut-off is 380 U/L, and there was no statistically significant difference between the two for diagnostic accuracy. According to gender, 206 patients were divided into 2 groups, and the ROC curves were drawn respectively. Based on statistical analysis, there was no statistically significant difference in the diagnostic accuracy of the two groups. In the male group, 436 U/L serum amylase provided the greatest diagnostic accuracy with sensitivity (SE) of 70.5%, specificity (SP) of 89.2%, positive predictive value (PPV) 87.5%, and negative predictive value (NPV) 78.1%. Whereas, in the female group, 357 U/L serum amylase provided the greatest diagnostic accuracy with sensitivity of 76.9%, specificity of 81.2%, positive predictive value of 80.4%, negative predictive value of 77.9%. Conclusions 1. The 3-h post-ERCP serum amylase level is a useful measurement for predicting post-ERCP pancreatitis. 2. There was no significant difference between serum amylase and lipase 3-h post-ERCP for predicting PEP. 3. There was no statistically significant difference between male and female using the 3-h post-ERCP serum amylase level to predict PEP. For female, the optimal cut-off value was 357 U/L, whereas male 436 U/L .
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Affiliation(s)
- Ze-Hui Lv
- Department of Gastroenterological Endoscopy, the First Affiliated Hospital of Dalian Medical University, 222 Zhongshan road, Xigang district, Dalian, 116011, Liaoning Province, China
| | - Da-Qing Kou
- Department of Clinical Laboratory, the First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning Province, China
| | - Shi-Bin Guo
- Department of Gastroenterological Endoscopy, the First Affiliated Hospital of Dalian Medical University, 222 Zhongshan road, Xigang district, Dalian, 116011, Liaoning Province, China.
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A grey zone of hyperamylasemia following endoscopic retrograde cholangiopancreatography: follow-up and differential diagnosis from acute pancreatitis. Wideochir Inne Tech Maloinwazyjne 2020; 16:38-44. [PMID: 33786115 PMCID: PMC7991937 DOI: 10.5114/wiitm.2020.94545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/13/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is a tool often used for treating and diagnosing pancreaticobiliary diseases. One of the important complications of ERCP is pancreatitis. Even though transient hyperamylasemia is a more common and benign situation, it must be distinguished from post-ERCP pancreatitis. Aim To define the risk factors associated with post-ERCP pancreatitis (PEP) and tried to identify a cutoff about laboratory findings for positive or negative prediction. Material and methods We reviewed the medical files of patients who underwent ERCP for choledocholithiasis in a retrospective cohort study. The primary outcome is the risk factors associated with PEP. Receiver operator characteristics analysis was carried out for determination of cut-offs for laboratory parameters. Results The presence of cholangitis (p = 0.018), Wirsung cannulation (p = 0.008), presence of abdominal pain at 12th and 24th h (p < 0.001), amylase level at 12th h (p < 0.001), C-reactive protein (CRP) levels at 6th and 12th h (p = 0.001 and p < 0.001), white blood cells (WBC) levels at 6th and 12th h (p = 0.001 and p < 0.001) were significant for development of PEP. CRP levels above 8 mg/l and WBC above 10 × 103 had negative predictive values over 70% and 90% respectively. Conclusions Physical examination and inflammatory parameters are important in diagnosis of PEP. CRP and WBC have high negative predictivity and sensitivity. Amylase level increase was most apparent 12 h after ERCP and significantly higher (p < 0.001) for the development of PEP. The first abdominal pain evaluation is meaningful at the 12th h timepoint because insufflation during the procedure and other causes of abdominal pain may result in misinterpretation.
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Serum lipase as a biomarker for early prediction and diagnosis of post-endoscopic retrograde cholangiopancreatography pancreatitis. Ir J Med Sci 2019; 189:163-170. [PMID: 31463894 DOI: 10.1007/s11845-019-02089-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Lipase is one of the diagnostic criteria for acute pancreatitis; however, the value of serum lipase in the early prediction and diagnosis for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis remains controversial. AIMS We evaluate the 3-h post-ERCP serum amylase and lipase activities for early prediction of postoperative pancreatitis (PEP) and compare the 24-h post-ERCP serum amylase and lipase activities in the diagnosis of PEP. METHODS Clinical information of patients who underwent ERCP from January 2017 to December 2018 at our hospital were retrospectively reviewed. Receiver operating characteristic (ROC) curves were performed for 3-h and 24-h post-ERCP serum amylase and lipase activities to evaluate predictive and diagnostic values, respectively. RESULTS A total of 498 cases with ERCP were finally enrolled, in which 36 cases of PEP were confirmed. ROC curves for 3-h post-ERCP amylase and lipase activities depicted areas under the curve (AUCs) of 0.88 (P < 0.001, 95% confidence intervals [CI] 0.82-0.93) and 0.90 (P < 0.001, 95% CI 0.86-0.93), respectively. The difference showed no significance using Z test (Z = 0.69, P > 0.05). AUCs for 24-h amylase and lipase activities were 0.83 (P < 0.001, 95% CI 0.77-0.89) and 0.94 (P < 0.001, 95% CI 0.90-0.99), respectively, and the difference was significant (Z = 3.04, P < 0.05). CONCLUSIONS For early prediction of PEP, 3-h post-ERCP serum lipase activity is at least as good as that of amylase. For diagnosis of PEP, 24-h post-ERCP serum lipase is a much better indicator than that of amylase. Together, this study suggests that serum lipase should be given priority in the early prediction and diagnosis of PEP.
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