Combination of Two-hour Post-ERCP Serum Amylase Level with Clinical Risk Factors for Predict Pancreatitis After Procedure
Article Sidebar
Main Article Content
Abstract
Background: Pancreatitis is the most common and life threatening complication of endoscopic retrograde cholangiopancreatography. Clinical factors are not reliable for diagnosis. Serum amylase is useful for early detection post-ERCP pancreatitis (PEP).
Objective: To evaluate the value of using 2 hour post-ERCP serum amylase level combine with clinical risk factors as a predictor of post-ERCP pancreatitis.
Methods: A prospective cohort study of consecutive patients who underwent ERCP from February 2017 to December 2019. Patients and procedure related risk factors as well as the 2 hour post ERCP amylase levels were analyzed.
Statistical analysis: Categorical variables were compare using Fisher’s exact test ,whereas continuous variables were compare using t-test. ROC curve analysis was used to determine the cutoff level of 2 hour serum amylase. Predictive factors were identified with multivariate logistic regression.
Results: A total 355 ERCP procedures were included in this study. Post-ERCP pancreatitis occurred in 41 patients (11.5%). Patients with PEP had 2 hour serum amylase level higher than non PEP group (421 vs 104 IU/L, P < 0.001). The cutoff value of 2 hour serum amylase was 124 IU/L (1.5 times of the upper normal limit) sensitivity 85.4% area under ROC curve 81.7%. By univariate analysis, significant risk factors were difficult cannulation (OR 3.02), pancreatic duct cannulation (OR 3.5), precut sphincterotomy (OR 3.67) and 2 hour serum amylase > 124 IU/L (OR 20.71). Multivariate analysis revealed that 2 hour serum amylase > 124 IU/L was a significant predictive factor for PEP (OR 14.78, 95%CI 5.66 – 38.59, P < 0.0001 ) . The area under ROC curve for predict PEP was significantly increase when using 2 hour serum amylase combine with clinical risk factors instead of clinical risk factors alone (AUC 84.9% VS 68.2%, P < 0.0001).
Conclusion: Combination of 2 hour post-ERCP serum amylase level combine with clinical risk factors is a reliable test to predict post ERCP pancreatitis
Keywords: Serum amylase, Post endoscopic retrograde cholangiopancreatography pancreatitis, Prediction
Article Details
References
Cohen S, Bacon BR, Berlin JA et al. National Institutes of Health State-of-the-science conference statement: ERCP for diagnosis and therapy, January 14-16, 2002. Gastrointest Endosc 2002;56(6):803-9.
Andriulli A, Loperfido S, Napolitano G et al. Incidence rates of post-ERCP complications: A systematic survey of prospective studies. Am J Gastroenterol 2007;102:1781-8.
Kochar B, Akshintala VS, Afghani E et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized controlled trials. Gastrointest Endosc 2015; 81:143-9.
Chandrasekhara V, Khashab MA, Muthusamy VR et al. Adverse events associated with ERCP. Gastrointest Endosc 2017;85:32-47.
Dumonceau JM, Andriulli A, Elmunzer BJ et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) guideline – updated June 2014. Endoscopy 2014;46:799-815.
Cotton PB, Lehman G, Vennes J et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991;37:383-93.
Freeman ML, DiSario JA, Nelson DB et al. Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Gastrointest Endosc 2001; 54:425-34.
Masci E, Mariani A, Curioni S, Testoni PA. Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: A meta-analysis. Endoscopy 2003;35:830-4.
Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc 2009;70:80-8.
Testoni PA, Bagnolo F, Caporuscio, Lella F. Serum amylase measured four hours after endoscopic sphincterotomy is a reliable predictor of postprocedure pancreatitis. Am J Gastroenterol 1999;94:1235-41.
LaFerla G, Gordon S, Archibald M, Murray WR. Hyperamylasemia and acute pancreatitis following endoscopic retrograde cholangiopancreatography. Pancreas 1986;1:160-3.
Gottlieb k, Sherman S, Pezzi J, Esber E, Lehman GA. Early recognition of post-ERCP pancreatitis by clinical assessment and serum pancreatic enzymes. Am J Gastroenterol 1996;91:1553-7.
Testoni PA. Caporuscio S, Bagnolo F, Lella F.Twenty-Four-Hour serum amylase predicting pancreatic reaction after endoscopic sphincterotomy. Endoscopy 1999;31:131-6.
Testoni PA, Bagnolo F. Pain at 24 hours associated with amylase levels greater than 5 times the upper normal limit as the most reliable indicator of post-ERCP pancreatitis. Gastrointest Endosc 2001;53:33-9.
Thomas PR, Sengupta S. Prediction of pancreatitis following endoscopic retrograde cholangiopancreatography by the 4-h post procedural amylase level. J Gastroenterol Hepatol 2001;16:923-6.
Christoforidis E, Goulimaris I, Kanellos I et al. Post-ERCP pancreatitis and hyperamylasemia: Patient-related and operative risk factors. Endoscopy 2002;34:286-92.
Ito K, Fujita N, Noda Y et al. Relationship between post-ERCP pancreatitis and change of serum amylase level after the procedure. World J Gastroenterol 2007;13:3855-60.
Hayashi S, Nishida T, Shimakoshi H et al. Combination of two-hour post-endoscopic retrograde cholangiopancreatography amylase levels and cannulation times is useful for predicting post-endoscopic retrograde cholangiopancreatography pancreatitis. World J Gastrointest Endosc 2016;8:777-84.
Lee YK, Yang MJ, Kim SS et al. Prediction of post-endoscopic retrograde cholangiopancreatography using 4-hour of post-endoscopic retrograde cholangiopancreatography serum amylase and lipase levels. J Korean Med Sci 2017;32(11):1814-1819
Jeurnink SM, Siersema PD, Steyerberg EW et al. Predictors of complications after endoscopic retrograde cholangiopancreatography: a prognostic model for early discharge. Surg Endosc 2011;25:2892-900.
