Prediction of Post-ERCP Pancreatitis by 4-Hour Post-ERCP Serum Amylase and Lipase Levels

Abstract

Background & Aims : Acute pancreatitis is the most common, serious complication of endoscopic retrograde cholangiopancreatography (ERCP). Early prediction of post-ERCP pancreatitis (PEP) could enable earlier safe discharge of patients on the same day after ERCP. This study investigated a predictive cut-off value of 4-hour post-ERCP serum amylase and lipase levels for PEP.

Methods : We retrospectively evaluated patients who underwent ERCP procedures and testing for serum amylase and lipase 4-hours after ERCP and the next morning at Ajou Medical Center from January 2012 to August 2013. We studied; patient demographics, procedure reasons, pancreatogram performance, and serum amylase and lipase levels.

Results : PEP occurred in 16 (3.1%) patients after 516 ERCP procedures. Its severity was mild in 4 (25%), moderate in 9 (56.3%), and severe in 3 (18.8%). Mean 4-hour amylase level was significantly higher in patients with PEP; than in those without (965 U/L vs. 158 U/L, P = .001). No statistically significant differences occurred in age, sex, and procedure reasons between both groups. Sensitivity, specificity and negative predictive value (NPV) of 4-hour post-ERCP amylase level with a cut-off value of 2.5x upper limit of reference (ULR) (290 U/L) were 39.1%, 98.5% and 97.2%, respectively; with a cut-off value of 8× ULR (480 U/L), they were 60.0%, 97.5% and 99.6%. The patient group undergoing pancreatogram had a high incidence of PEP; but no significant difference in 4-hour post-ERCP serum amylase and lipase, compared with its counterpart.

Conclusions : Four-hour post-ERCP serum amylase and lipase levels with cut-off values of 2.5x and 8x ULR are proven useful predictive values for earlier safe discharge of patients on the same day after ERCP.