Use of the urinary trypsinogen-2 dip stick test in early diagnosis of pancreatitis after endoscopic retrograde cholangiopancreatography.
BACKGROUND
This study aimed to prove that the urinary trypsinogen-2 dip stick test can be used for early diagnosis of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).


METHODS
For this prospective, blinded, pilot study, urine samples were collected before ERCP, 1 h after ERCP, and 4 h after ERCP. The urine dipstick test was used to detect trypsinogen-2 on the basis of immunochromatography. The dipstick results were compared with those of current methods used to diagnose post-ERCP pancreatitis. Once the patient disposition was finalized, pancreatic enzymes, clinical findings, and final diagnosis were obtained from the chart and compared with the urine trypsinogen-2 test findings. The sensitivity, specificity, and positive and negative predictive values were calculated.


RESULTS
The urine trypsinogen dip stick test was performed for 30 patients (15 men and 15 women). Post-ERCP pancreatitis was diagnosed in 5 of 29 patients by clinician assessment, serum pancreatic enzyme levels, or both. The amylase and lipase levels for post-ERCP patients with and without pancreatitis were 650 +/- 145 vs 134 +/- 26 (p = 0.023) and 1,658 +/- 594 vs 84 +/- 17 (p = 0.057), respectively. This statement proves that patients who developed post ERCP pancreatitis had significant elevation of amylase and lipase compared to patients who did not have pancreatitis. For the dip stick test, 6 of 28 patients had positive results in 1 h and 6 of 29 patients had positive results in 4 h. The sensitivity of the 1-h test was 1.0, and the specificity was 0.91. The positive predictive value (PPV) was 0.66, and the negative predictive value (NPV) was 1.0. The sensitivity of the 4-h test was 1.0, and the specificity was 0.96. The PPV was 0.8, and NPV value was 1.0.


CONCLUSIONS
The urinary trypsinogen-2 dip stick test is useful for early diagnosis of post-ERCP pancreatitis and allows the testing physicians to begin management early in its course.
Sankaralingam
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Department of Surgery, St. John Hospital and Medical Center, 22101 Moross Road, Detroit, MI 48236, USA. senthilmed@yahoo.com
Wesen
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Barawi
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Galera
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Lloyd
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D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D015415:Biomarkers / Q000652:urine; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011934:Reagent Strips; D012680:Sensitivity and Specificity; D014357:Trypsin / Q000652:urine*; D014362:Trypsinogen / Q000652:urine*
D015415:Biomarkers; D011934:Reagent Strips; C064831:PRSS2 protein, human; D014362:Trypsinogen; D000681:Amylases; D014357:Trypsin