Predicting post‐endoscopic retrograde cholangiopancreatography pancreatitis using the 4‐h serum lipase level

Papachristos, Alexander; Howard, T. Leon; Thomson, Benjamin; Thomas, Peter

doi:10.1111/ans.13665

Cited by 15 publications

(21 citation statements)

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“…Serum lipase is a specific diagnostic indicator of pancreatitis. Its activity is maintained longer than amylase, and there is no other source in the blood [24], so it is considered to be more sensitive than serum amylase (95%;79%). The British guidelines for the diagnosis and treatment of acute pancreatitis in 2005 indicated that the pancreas is the only source of lipase and is superior to amylase in terms of sensitivity, specificity and accuracy [25].…”

Section: Discussionmentioning

confidence: 99%

Three-hour post-ERCP amylase level: a useful indicator for early prediction of post-ERCP pancreatitis

Kou

Guo

2020

BMC Gastroenterol

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Background: To evaluate the value of the 3-h post-ERCP serum amylase level for early prediction of post-ERCP pancreatitis (PEP). Method: A study of 206 patients performed ERCP (Encoscopic Retrograde Cholangio-Pancreatography) at a single centre was done from Jan. 2011 to Nov. 2016. The serum amylase or lipase level was measured at 3 h after ERCP. The patients with PEP were recorded. ROC curves were used to statistically analyze the data: The enrolled patients were divided into two groups according to gender, then we analyzed the data respectively. We comprehensively evaluated the predictive value of PEP by 3-h post-ERCP serum amylase level based on the results above. Results: Two hundred six patients (92 males, 114 females) were enrolled. PEP occurred in 21 patients (10.19%) among them. The median time to discharge was 7 days (min = 1d, max = 13d) after the procedure. In the 206 patients, the 3-h post-ERCP pancreatic amylase level was used as the test variable, and the PEP occurrence as the state variable to plot the ROC curve. The area under the curve (AUC) was 0.816, and was statistically significant (P < 0.001). The standard error (SE) was 0.0507, the 95% confidence interval (CI) was 0.756-0.866, and the optimal cutoff value was 351 U/L (sensitivity 76.19%, specificity 83.24%, positive likelihood ratio 4.55, negative likelihood ratio 0.29, Youden index 59.43%). Of the 206 patients, there were 83 patients with both 3-h post-ERCP amylase level and lipase level detected, and the ROC curves were plotted for both serum amylase and lipase respectively. The ROC curve matched-pair testing was carried out: The areas under the ROC curves were statistically significant. (P < 0.001) The area under the ROC curve for the 3-h post-ERCP lipase was 0.778, the 95% confidence interval was 0.673-0.862, and optimal cutoff value was 1834 U/L. The area under the ROC curve for the 3-h post-ERCP serum amylase was 0.780, and the 95% confidence interval was 0.676-0.864. The optimal cutoff is 380 U/L, and there was no statistically significant difference between the two for diagnostic accuracy. According to gender, 206 patients were divided into 2 groups, and the ROC curves were drawn respectively. Based on statistical analysis, there was no statistically significant difference in the diagnostic accuracy of the two groups. In the male group, 436 U/L serum amylase provided the greatest diagnostic accuracy with sensitivity (SE) of 70.5%, specificity (SP) of 89.2%, positive predictive value (PPV) 87.5%, and negative predictive value (NPV) 78.1%. Whereas, in the female group, 357 U/L

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Section: Discussionmentioning

confidence: 99%

Three-hour post-ERCP amylase level: a useful indicator for early prediction of post-ERCP pancreatitis

Kou

Guo

2020

BMC Gastroenterol

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“…After the removal of duplicates, 241 studies were screened. Of these, 179 were excluded, and full texts of 62 articles were reviewed that ultimately led to 18 studies that met the inclusion criteria 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ( Supplemental Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

Early prediction of post-ERCP pancreatitis by post-procedure amylase and lipase levels: A systematic review and meta-analysis

et al. 2022

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Background and study aims Post-ERCP pancreatitis (PEP) is the most common complication attributed to the procedure, its incidence being approximately 9.7 %. Numerous studies have evaluated the predictive efficacy of post-procedure serum amylase and lipase levels but with varied procedure-to-test time intervals and cut-off values. The aim of this meta-analysis was to present pooled data from available studies to compare the predictive accuracies of serum amylase and lipase for PEP. Patients and methods A total of 18 studies were identified after a comprehensive search of various databases until June 2021 that reported the use of pancreatic enzymes for PEP. Results The sample size consisted of 11,790 ERCPs, of which PEP occurred in 764 (6.48 %). Subgroups for serum lipase and amylase were created based on the cut-off used for diagnosing PEP, and meta-analysis was done for each subgroup. Results showed that serum lipase more than three to four times the upper limit of normal (ULN) performed within 2 to 4 hours of ERCP had the highest pooled sensitivity (92 %) for PEP. Amylase level more than five to six times the ULN was the most specific serum marker with a pooled specificity of 93 %. Conclusions Our analysis indicates that a lipase level less than three times the ULN within 2 to 4 hours of ERCP can be used as a good predictor to rule out PEP when used as an adjunct to patient clinical presentation. Multicenter randomized controlled trials using lipase and amylase are warranted to further evaluate their PEP predictive accuracy, especially in high-risk patients.

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“…Nuestros resultados confirman que existe correlación entre la elevación enzimática y la presencia y la gravedad de la PPCPRE para el caso de la lipasa sérica, como se reporta en otras publicaciones 2,11,25 cuyo valor de corte tiene un valor predictivo negativo del 92.5%, por lo que se podrían utilizar las cifras menores de este valor de corte para descartar PP-CPRE moderadamente grave o grave. En el caso de la amilasa también existe una correlación menos importante y sin significancia estadística.…”

Section: Discussionunclassified

Utilidad de la amilasa y la lipasa séricas como predictores de gravedad en la pancreatitis poscolangiopancreatografía retrógrada endoscópica

Martínez-Segundo¹,

Pinto-Angulo²,

García-Álvarez

et al. 2020

CIRU

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Predicting post‐endoscopic retrograde cholangiopancreatography pancreatitis using the 4‐h serum lipase level

Cited by 15 publications

References 21 publications

Three-hour post-ERCP amylase level: a useful indicator for early prediction of post-ERCP pancreatitis

Three-hour post-ERCP amylase level: a useful indicator for early prediction of post-ERCP pancreatitis

Early prediction of post-ERCP pancreatitis by post-procedure amylase and lipase levels: A systematic review and meta-analysis

Utilidad de la amilasa y la lipasa séricas como predictores de gravedad en la pancreatitis poscolangiopancreatografía retrógrada endoscópica

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