Early recognition of post-ERCP pancreatitis by clinical assessment and serum pancreatic enzymes.
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 of outpatients undergoing ERCP at a time when careful utilization of resources, especially the avoidance of unnecessary hospital admissions, becomes increasingly more important.
Gottlieb
K
K
Indiana University Medical Center, Indianapolis, USA.
Sherman
S
S
Pezzi
J
J
Esber
E
E
Lehman
G A
GA
D015746:Abdominal Pain / Q000209:etiology; D000465:Algorithms; D000553:Ambulatory Care; D000681:Amylases / Q000097:blood*; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004796:Clinical Enzyme Tests; D005069:Evaluation Studies as Topic; D006801:Humans; D008049:Lipase / Q000097:blood*; D010195:Pancreatitis / Q000175:diagnosis* / Q000209:etiology*; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
D008049:Lipase; D000681:Amylases