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

Background Endoscopic retrograde cholangiopancreatography ( ERCP ) is a complex therapeutic procedure that is complicated by pancreatitis in 3–5% of cases. The aim of this study is to determine whether a 4‐h post‐ ERCP serum lipase level is superior to the serum amylase level in predicting the occurrence of post‐ ERCP pancreatitis ( PEP ). Methods We performed a retrospective review of prospectively collected data on 543 consecutive patients undergoing therapeutic ERCP at a single centre. Serum lipase and amylase levels were measured at 4‐h post‐procedure and were recorded as a factor of the upper limit of normal: amylase factor ( AF ) and lipase factor ( LF ). Sensitivity and specificity were compared using receiver‐operating characteristics and the Youden index ( YI ). Results A total of 506 procedures were considered for analysis. PEP occurred in 19 patients (3.8%). A LF of <10 was useful for the exclusion of PEP with a sensitivity of 100% and a specificity of 94%, YI = 0.94. In contrast, an AF <3 yielded a sensitivity of 79% and specificity of 94%, YI = 0.73. Conclusion Serum lipase measured at 4‐h post‐ ERCP better excludes PEP than serum amylase measured at the same time point. Patients with a LF <10 may be safely considered for same‐day discharge.