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. 2021 Mar;16(1):38-44.
doi: 10.5114/wiitm.2020.94545. Epub 2020 Apr 18.

A grey zone of hyperamylasemia following endoscopic retrograde cholangiopancreatography: follow-up and differential diagnosis from acute pancreatitis

Mikail Cakir  1 , Adnan Hut  1 , Okan Murat Akturk  1 , Busra Ekinci Biçkici  1 , Dogan Yildirim  1
Affiliations

A grey zone of hyperamylasemia following endoscopic retrograde cholangiopancreatography: follow-up and differential diagnosis from acute pancreatitis

Mikail Cakir et al. Wideochir Inne Tech Maloinwazyjne. 2021 Mar.

Abstract

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a tool often used for treating and diagnosing pancreaticobiliary diseases. One of the important complications of ERCP is pancreatitis. Even though transient hyperamylasemia is a more common and benign situation, it must be distinguished from post-ERCP pancreatitis.

Aim: To define the risk factors associated with post-ERCP pancreatitis (PEP) and tried to identify a cutoff about laboratory findings for positive or negative prediction.

Material and methods: We reviewed the medical files of patients who underwent ERCP for choledocholithiasis in a retrospective cohort study. The primary outcome is the risk factors associated with PEP. Receiver operator characteristics analysis was carried out for determination of cut-offs for laboratory parameters.

Results: The presence of cholangitis (p = 0.018), Wirsung cannulation (p = 0.008), presence of abdominal pain at 12th and 24th h (p < 0.001), amylase level at 12th h (p < 0.001), C-reactive protein (CRP) levels at 6th and 12th h (p = 0.001 and p < 0.001), white blood cells (WBC) levels at 6th and 12th h (p = 0.001 and p < 0.001) were significant for development of PEP. CRP levels above 8 mg/l and WBC above 10 × 103 had negative predictive values over 70% and 90% respectively.

Conclusions: Physical examination and inflammatory parameters are important in diagnosis of PEP. CRP and WBC have high negative predictivity and sensitivity. Amylase level increase was most apparent 12 h after ERCP and significantly higher (p < 0.001) for the development of PEP. The first abdominal pain evaluation is meaningful at the 12th h timepoint because insufflation during the procedure and other causes of abdominal pain may result in misinterpretation.

Keywords: acute pancreatitis; endoscopic retrograde cholangiopancreatography; hyperamylasemia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Photo 1
Photo 1
Choledocholithiasis. From the archives of Endoscopic Surgery Unit
Photo 2
Photo 2
Stent in the duodenal papilla. From the archives of Endoscopic Surgery Unit
Figure 1
Figure 1
Receiver operating characteristic curves of CRP and WBC for post-ERCP pancreatitis
See this image and copyright information in PMC

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