title: Predicting post-endoscopic retrograde cholangiopancreatography pancreatitis using the 4-h serum lipase level.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.|Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Papachristos
authors.affiliation: Department of Surgery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
authors.forename: Tess
authors.initials: T
authors.lastname: Howard
authors.affiliation: Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Thomson
authors.affiliation: Department of Surgery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.|Rural Clinical School, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood*; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008049:Lipase / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D055815:Young Adult
chemical_list: D008049:Lipase; D000681:Amylases
keywords: 
  ERCP
  ; amylase; lipase; pancreatitis; rural health