The value of serum amylase and elastase measurements in the prediction of post-ERCP acute pancreatitis.
OBJECTIVE
Acute pancreatitis is the most serious complication of endoscopic retrograde cholangiopancreatography (ERCP) but is not very common. A test that could predict the occurrence of pancreatitis would help to decide whether to discharge a patient after ERCP or not. The aim of this prospective study was to compare the value of serum amylase and elastase in the prediction of post-ERCP pancreatitis and its severity.


METHODS
Ninety-seven patients underwent ERCP. Serum samples were taken before, two and six hours after ERCP for amylase and elastase measurement. Fifty-four patients (group A) were treated with continuous intravenous infusion of octreotide, beginning 6 hours before ERCP and terminating 24 hours after. Forty-three patients (group B) received no preventive treatment.


RESULTS
In group A, 9 patients (16.6%) developed pancreatitis, 8 of them (14.8%) mild and 1 (1.8%) severe. Two patients in group B developed mild pancreatitis (p = 0.1). In all patients the predictive accuracy in the second hour for amylase >3N, >5N and elastase >N was 79%, 87% and 86% respectively. The likelihood ratio of positivity (LRP) was 3.6, 6.5 and 6.1. In the sixth hour the respective values were 76%, 86%, 85% and 4, 7.3 and 6.4. In group A, the respective values in the second hour were 85%, 91%, 94% and 5, 25.2, infinity, and in the sixth hour 85%, 94%, 98% and 5.7, 11.5, infinity.


CONCLUSIONS
Serum amylase (with cutoff value >5N) and elastase (>N), 6 hours after ERCP, were the most accurate tests for the prediction of post-ERCP pancreatitis, especially in patients receiving octreotide. The measurement of serum elastase could supplement that of serum amylase in the prediction of more cases of post-ERCP pancreatitis.
Kapetanos
Dimitrios
D
Gastroenterology Department, George Papanikolaou General Hospital, Thessaloniki, Greece.
Kokozidis
George
G
Kinigopoulou
Penelopi
P
Xiarchos
Panagiotis
P
Antonopoulos
Zissis
Z
Progia
Evagelia
E
Kitis
George
G
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage; D010196:Pancreatic Elastase / Q000097:blood*; D010195:Pancreatitis / Q000175:diagnosis* / Q000201:enzymology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011292:Premedication; D011446:Prospective Studies; D012372:ROC Curve
D000681:Amylases; D010196:Pancreatic Elastase; D015282:Octreotide