title: Combination of two-hour post-endoscopic retrograde cholangiopancreatography amylase levels and cannulation times is useful for predicting post-endoscopic retrograde cholangiopancreatography pancreatitis.
abstract: OBJECTIVE
  To estimate the efficacy of 2 h post-endoscopic retrograde cholangiopancreatography (ERCP) serum amylase levels and other factors for predicting post-ERCP pancreatitis.
  
  
  METHODS
  This was a retrospective, single-center cohort study of consecutive patients who underwent ERCP from January 2010 to December 2013. Serum amylase levels were measured 2 h post-procedure, and patient- and procedure-related pancreatitis (PEP) risk factors were analyzed using a logistic model.
  
  
  RESULTS
  A total of 1520 cases (average age 72 ± 12 years, 60% male) were initially enrolled in this study, and 1403 cases (725 patients) were ultimately analyzed after the exclusion of 117 cases. Fifty-five of these cases developed PEP. We established a 2 h serum amylase cutoff level of two times the upper limit of normal for predicting PEP. Multivariate analysis revealed that a cannulation time of more than 13 min [odds ratio (OR) 2.28, 95%CI: 1.132-4.651,P= 0.0210] and 2 h amylase levels greater than the cutoff level (OR = 24.1, 95%CI: 11.56-57.13,P< 0.0001) were significant predictive factors for PEP. Forty-seven of the 55 patients who developed PEP exhibited 2 h amylase levels greater than the cutoff level (85%), and six of the remaining eight patients who developed PEP (75%) required longer cannulation times. Only 2 of the 1403 patients (0.14%) who developed PEP did not exhibit concerning 2 h amylase levels or require longer cannulation times.
  
  
  CONCLUSIONS
  These findings indicate that the combination of 2 h post-ERCP serum amylase levels and cannulation times represents a valuable marker for identifying patients at high risk for PEP.
authors.affiliation: Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Hayashi
authors.affiliation: Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nishida
authors.affiliation: Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Shimakoshi
authors.affiliation: Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Shimoda
authors.affiliation: Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Amano
authors.affiliation: Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Sugimoto
authors.affiliation: Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Mukai
authors.affiliation: Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Tokuhiro
authors.initials: T
authors.lastname: Matsubara
authors.affiliation: Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Nakajima
authors.affiliation: Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Fukui
authors.affiliation: Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Inada
keywords: Cannulation time; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Predictor; Serum amylase levels