Prediction of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Using 4-Hour Post-Endoscopic Retrograde Cholangiopancreatography Serum Amylase and Lipase Levels

Abstract

Early post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prediction may allow safe same-day outpatients discharge after ERCP and earlier proper management. This study aimed to assess the usefulness of the 4-hour post-ERCP serum amylase and lipase levels for PEP early prediction and to investigate predictive cut-off values for 4-hour post-ERCP serum amylase and lipase levels for safe discharge and urgent initiation of resuscitation. The data of 516 consecutive patients with native papilla who underwent ERCP between January 2013 and August 2014 were retrospectively reviewed. Serum amylase and lipase levels were measured before, and 4 and 24 hours after ERCP. PEP occurred in 16 (3.1%) patients. The receiver-operator characteristic curve for 4-hour post-ERCP serum amylase and lipase levels showed that the areas under the curve were 0.919 and 0.933, respectively, demonstrating good test performances as predictors for PEP (both P values < 0.001). The amylase level > 1.5 × the upper limit of reference (ULR) was found useful for PEP exclusion with a sensitivity of 93.8%, while 4 × ULR was found useful to guide preventive therapy with the best specificity of 93.2%. Similarly, the lipase level 2 × ULR showed best sensitivity, while 8 × ULR had the best specificity. Logistic regression analysis showed that 4-hour post-ERCP amylase level > 4 × ULR, lipase level > 8 × ULR, precut sphincterotomy, and pancreatic sphincterotomy were significant predictors for PEP. In conclusion, 4-hour post-ERCP amylase and lipase levels are useful early predictors of PEP that can ensure safe discharge or prompt resuscitation after ERCP.

Keywords: Amylases; Cholangiopancreatography; Endoscopic Retrograde; Lipase; Pancreatitis.

Fig. 1

Receiver-operator characteristics curve for 4-hour post-ERCP amylase levels as a predictor of PEP. Area under the curve = 0.919 (P < 0.001). The cut-off levels of 1.5 times the ULR is useful for exclusion of PEP with a sensitivity of 93.8%, and 4 times the ULR is useful to guide preventive therapy of PEP with a best specificity of 93.2%. ERCP = endoscopic retrograde cholangiopancreatography, PEP = post-ERCP pancreatitis, ULR = upper limit of reference.

Fig. 2

Receiver-operator characteristics curve for 4-hour post-ERCP lipase levels as a predictor of PEP. Area under the curve = 0.933 (P < 0.001). The cut-off levels of 2 times the ULR is useful for exclusion of PEP with a sensitivity of 93.8%, and 4 times the ULR is useful to guide preventive therapy of PEP with a best specificity of 91.4%. ERCP = endoscopic retrograde cholangiopancreatography, PEP = post-ERCP pancreatitis, ULR = upper limit of reference.