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. 1997 Nov;41(5):690-5.
doi: 10.1136/gut.41.5.690.

Increased serum trypsinogen 2 and trypsin 2-alpha 1 antitrypsin complex values identify endoscopic retrograde cholangiopancreatography induced pancreatitis with high accuracy

E Kemppainen  1 , J Hedström, P Puolakkainen, J Halttunen, V Sainio, R Haapiainen, E Kivilaakso, U H Stenman
Affiliations

Increased serum trypsinogen 2 and trypsin 2-alpha 1 antitrypsin complex values identify endoscopic retrograde cholangiopancreatography induced pancreatitis with high accuracy

E Kemppainen et al. Gut. 1997 Nov.

Abstract

Aims: To evaluate the clinical utility of two new tests for serum trypsinogen 2 and trypsin 2-alpha 1 antitrypsin complex (trypsin 2-AAT) in diagnosing and assessing the severity of acute pancreatitis (AP) induced by endoscopic retrograde cholangiopancreatography (ERCP).

Patients: Three hundred and eight consecutive patients undergoing ERCP at Helsinki University Central Hospital in 1994 and 1995.

Methods: Patients were followed prospectively for pancreatitis and clinical outcome. They were tested for serum trypsinogen 2, trypsin 2-AAT, and amylase in samples obtained before and one, six, and 24 hours after ERCP.

Results: Pancreatitis developed in 31 patients (10%). Their median serum trypsinogen 2 increased 26-fold to 1401 micrograms/l at six hours after the procedure and trypsin 2-AAT showed an 11-fold increase to 88 micrograms/l at 24 hours. The increase in both markers was stronger in severe than in mild pancreatitis, and in patients without pancreatitis there was no significant increase. Baseline trypsinogen 2 and trypsin 2-AAT concentrations were elevated in 29% and 32% of patients, respectively. The diagnostic accuracy of a threefold elevation over the baseline value was therefore analysed. The sensitivity and specificity of these parameters in the diagnosis of post-ERCP pancreatitis was 93% and 91%, respectively, for serum trypsinogen 2 at six hours after the examination, and 93% and 90%, for trypsin 2-AAT at 24 hours.

Conclusions: Serum trypsinogen 2 and trypsin 2-AAT reflect pancreatic injury after ERCP. High concentrations are associated with severe pancreatic damage. The delayed increase in trypsin 2-AAT compared with trypsinogen 2 appears to reflect the pathophysiology of AP. A greater than threefold increase in trypsinogen 2 six hours after ERCP is an accurate indicator of pancreatitis.

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Figures

Figure 1
Figure 1
: Box plots showing the concentration of serum trypsinogen 2 (25-75% interquartile range, mean, 95% range, and outliners) in patients without pancreatitis, with mild pancreatitis, and with severe pancreatitis before, and at one, six, and 24 hours after ERCP.
Figure 2
Figure 2
: Concentrations of trypsin 2-AAT before, and at one, six, and 24 hours after ERCP.
Figure 3
Figure 3
: Correlations of trypsinogen 2 and amylase before and six hours after ERCP, and trypsin 2-AAT and amylase before and 24 hours after the procedure. Filled circles, ERCP induced pancreatitis; open circles, no pancreatitis.
Figure 4
Figure 4
: Scattergram of the correlation between trypsinogen 2 at six hours and serum trypsin 2-AAT at 24 hours after the examination (n=308).
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