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. 2023 Jan 31:28:5.
doi: 10.4103/jrms.jrms_273_21. eCollection 2023.

High amylase concentration in drainage liquid can early predict proximal and distal intestinal anastomotic leakages: A prospective observational study

Koceila Amroun  1   2 , Sophie Deguelte  1   2 , Zoubir Djerada  3   2 , Laurent Ramont  4   2 , Cyril Perrenot  1   2 , Linda Rached  1   2 , Yohan Renard  1   2 , Rami Rhaiem  1   2 , Reza Kianmanesh  1   2
Affiliations

High amylase concentration in drainage liquid can early predict proximal and distal intestinal anastomotic leakages: A prospective observational study

Koceila Amroun et al. J Res Med Sci. .

Abstract

Background: Anastomotic leak (AL) is a serious complication in digestive surgery. Early diagnosis might allow clinicians to anticipate appropriate management. The aim of this study was to assess the predictive value of amylase concentration in drain fluid for the early diagnosis of digestive tract AL.

Materials and methods: Hundred and fourteen consecutive patients "at risk" of AL, in whom a flexible drainage was placed by surgeon's choice after digestive anastomosis were included. Patients with eso-gastric, bilio-digestive, and pancreatic anastomoses were excluded. Drain amylase measurement (DAM) was routinely performed on postoperative day (POD) 1, 3, 5-7. DAM values were compared between patients with postoperative AL versus patients without AL. A receiver-operating curve (ROC) with calculation of the areas under the ROC curves area under curves was performed and a cutoff value of DAM was calculated.

Results: AL occurred in 25 patients (AL group) and 89 patients did not present AL (C group). The mean DAM was significantly higher in AL group versus C Group on POD 1, 3, and 5. A cutoff value of 307 IU/L predicted the occurrence of AL with a sensitivity and specificity of 91% and 100%, respectively. Positive and negative predictive values were 100% and 97.5%, respectively. Patients with AL had an elevated DAM prior to the appearance of any clinical signs of AL.

Conclusion: High level DAM could accurately predict AL for proximal and distal digestive tract anastomoses. This simple, noninvasive, and low-cost method can accurately predict early AL and help physicians to perform appropriate imaging and treatment.

Keywords: Amylase; anastomotic leakage; digestive anastomosis; drain fluid.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
AL occurrence and predicted probability of AL (interpolation line) with respect to DA level (IU/L). AL=Anastomotic leak, DS=Drain amylase
Figure 2
Figure 2
The ROC analysis with an AUC = 0.982 (95%CI [0.959 to 1.000], P< 0.0001). ROC = Receiver operator curve, AUC = Area under curve. CI = confidence interval
Figure 3
Figure 3
Comparison of drain amylase concentrations between patients with and without AL (median [min-max]: 9808 [40 – 117361] vs. 33 [4–283] respectively, P < 0.0001). Cut-off value of drain amylase level of 307 IU/L (almost 3 times normal serum level) is highly correlated to the presence of AL in proximal and distal digestive anastomosis. AL = Anastomotic leak
See this image and copyright information in PMC

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