[Serum lipase activity and evocation test after endoscopic retrograde cholangio-pancreatography (author's transl)]

Abstract

Serum lipase activity, which is a more specific indicator of pancreatic damage than serum amylase activity, was determined in 51 patients before and immediately after endoscopic retrograde cholangio-pancreatography (ERCP) and 24 hours subsequently. An increase in serum lipase activity without clinical signs of acute pancreatitis was observed immediately after pancreatography in 20 cases. Increased serum lipase activity after 24 hours is largely observed in patients with parenchymography or those displaying increased values already in the fasting state before ERCP. This observation emphasizes the need for caution in the assessment of the indication for ERCP in patients with preexisting increased serum lipase activity in view of the very real risk of acute pancreatitis and the need to avoid parenchymography of the pancreas. According to our experience the addition of a broadspectrum antibiotic such as gentamycin to the contrast medium may, to a large extent, avoid the development of acute pancreatitis. Lipase evocation tests carried out 10 days after the ERCP showed negative results in patients with increased enzyme activity and parenchymography after pancreatography. Hence, it is concluded that ERCP causes symptomless reversible biochemical pancreatic changes, as opposed to irreversible pancreatic damage.