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

Abstract

Background: To evaluate the value of the 3-hour post-ERCP serum amylase level for early prediction of post-ERCP pancreatitis (PEP). Method: A study of 206 patients performed ERCP was analysed. The patients with PEP were recorded. ROC curves were used to statistically analyze the data. Results: PEP occurred in 21 patients (10.19%). The 3-hour post-ERCP pancreatic amylase level was used as the test variable, and the PEP occurrence as the state variable to plot 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 cut-off value was 351U/L (sensitivity 76.19%, specificity 83.24%, positive likelihood ratio 4.55, negative likelihood ratio 0.29, Youden index 59.43%). The ROC curves were plotted for both serum amylase and lipase respectively. The areas under the ROC curves were statistically significant(P<0.001). The area under the ROC curve for the 3-hour post-ERCP lipase was 0.778, the 95% confidence interval was 0.673-0.862, and optimal cut-off value was 1834 U/L. The area under the ROC curve for the 3-hour post-ERCP serum amylase was 0.780, and the 95% confidence interval was 0.676-0.864. The optimal cut-off is 380U/L, and there was no statistically significant difference between the two for diagnostic accuracy. According to gender, there was no statistically significant difference in the diagnostic accuracy. 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, 357U/L serum amylase provided the greatest diagnostic accuracy with sensitivity of 76.9%, specificity of 81.2%, positive predictive value of 80.4%, negative predictive value of 77.9%. Conclusions: 1. The 3-hour post-ERCP serum amylase level is a useful measurement for predicting post-ERCP pancreatitis. 2. There was no significant difference between serum amylase and lipase 3-hour post-ERCP for predicting PEP. 3. There was no statistically significant difference between male and female using the 3-hour post-ERCP serum amylase level to predict PEP. For female, the optimal cut-off value was 357 U/L, whereas male 436U/L .

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

“…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 ).…”

“…All studies except one 14 were performed at a single center. Seven studies were prospective 14 15 16 20 25 26 27 while 11 were retrospective 11 12 13 17 18 19 20 21 22 23 24 28 in design. Ten studies were from Asia 13 14 15 17 18 20 21 24 27 28 , three each from Europe 9 16 25 and Australia 22 23 26 and two from the United States 11 12 .…”

“…Seven studies were prospective 14 15 16 20 25 26 27 while 11 were retrospective 11 12 13 17 18 19 20 21 22 23 24 28 in design. Ten studies were from Asia 13 14 15 17 18 20 21 24 27 28 , three each from Europe 9 16 25 and Australia 22 23 26 and two from the United States 11 12 . Six studies reported the setting of ERCPs 11 13 14 15 16 23 25 26 with one being 100 % inpatient 21 , two being 100 % outpatient 12 13 , two being mixed 11 19 and one mostly outpatient 23 (exact incidence not given).…”

“…Six studies reported the setting of ERCPs 11 13 14 15 16 23 25 26 with one being 100 % inpatient 21 , two being 100 % outpatient 12 13 , two being mixed 11 19 and one mostly outpatient 23 (exact incidence not given). Indications of ERCP were reported by 12 studies 11 13 14 15 16 17 18 19 22 23 26 27 , with choledocholithiasis being the most common indication followed by malignancy.…”

“…▶ 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).…”