Prospective study of prediction of post-ERCP pancreatitis by 4-hour and 6-hour post-ERCP serum amylase and lipase level
Introduction: Acute pancreatitis is the most common and serious adverse event of endoscopic retrograde cholangiopancreatography (ERCP).Aim: To evaluate the usefulness of 4-hour and 6-hour post-ERCP serum amylase and lipase levels for predicting PEP and set optimal cut-off values of them. Background: Early prediction of post-ERCP pancreatitis (PEP) could enable earlier safe same-day discharge of outpatients after ERCP and earlier proper management of PEP in all the patients. Method: We prospectively select patients who receive ERCP with hospital care between October 2015 and June 2016. Their serum amylase and lipase levels are measured 4-hours and 6-hours after ERCP as well as the next morning. We select optimal cut-off values with balanced upper-most sensitivity and specificity.
Results: PEP occurred in 19 (3.9%) patients after 480 ERCP procedures. The receiver-operator characteristic curve for 4-hour post-ERCP serum amylase and lipase showed that areas under the curve were 0.884 and 0.877, demonstrating good test performances as a predictor of PEP (both P<0.001). ROC curve for 6-hour post-ERCP serum amylase and lipase showed that AUC were 0.928 and 0.895. In pairwise comparisons of the ROC curves of 4-hours and 6-hours post ERCP amylase and lipase, the 4-hours amylase and lipase found to have significantly higher predictive power than 6-hours of them (p¼0.0258, p¼0.0255, rspectively). Female sex, therapeutic procedure, prior EST and longer total procedure time were identified as the risk factors for PEP. The optimal cut-off value of 4-hour post-ERCP serum amylase and lipase level for prediction of PEP were the 2 times the upper lime of reference (ULR) and 4 times the ULR, respectively. In case of 6-hour post-ERCP, the optimal cut-off values were the 2.5 times the ULR of serum amylase level and the 6 times the ULR of serum lipase level.
Conclusion: Although both the 4-hour and 6-hour post-ERCP serum amylase and lipase levels would be useful measures for predicting PEP, their 6-hour levels seem to be superior to their 4-hour levels.
翻译：胡越 审校：张立超 侯森林 （Pancreatology 2017）