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MORE ACCURATE PREDICTION OF POST‐ERCP PANCREATITIS BY 4‐H SERUM LIPASE LEVELS THAN AMYLASE LEVELS
Author(s) -
Nishino Takayoshi,
Toki Fumitake,
Oyama Hiroyasu,
Shiratori Keiko
Publication year - 2008
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2008.00802.x
Subject(s) - medicine , hyperamylasemia , lipase , pancreatitis , gastroenterology , receiver operating characteristic , endoscopic retrograde cholangiopancreatography , amylase , area under the curve , abdominal pain , enzyme , biochemistry , chemistry
Background: The aim of the present study was to evaluate and compare 4‐h post‐endoscopic retrograde cholangiopancreatography (ERCP) hyperamylasemia and hyperlipasemia as predictors of post‐ERCP pancreatitis. Methods: We reviewed 1631 consecutive cases consisting of 910 cases of diagnostic ERCP and 721 cases of therapeutic ERCP. Pancreatitis was diagnosed when abdominal pain persisted for 24 h after ERCP and the pain was associated with high serum amylase level and/or lipase level. Results: Pancreatitis developed in 69 (4.2%) of the 1631 cases. The receiver‐operator characteristic (ROC) curve of both the 4‐h amylase level and the 4‐h lipase level after diagnostic ERCP showed good test performance, with area under the curve of 0.88 (95% CI: 0.85–0.91) and 0.94 (95% CI: 0.92–0.96), respectively. The ROC of both the 4‐h amylase level and the 4‐h lipase level after therapeutic ERCP also showed good test performance, with an area under the curve of 0.92 (95% CI: 0.90–0.93) and 0.96 (95% CI: 0.94–0.97), respectively. The optimal cut‐off value for lipase after both diagnostic and therapeutic ERCP was 10‐fold the upper limit of the normal range. The serum lipase value after both diagnostic ERCP ( P = 0.025) and therapeutic ERCP ( P = 0.035) was a more effective predictor of post‐ERCP pancreatitis based on the areas under the ROC curve than was the serum amylase value. Conclusions: The 4‐h post‐ERCP lipase value is more useful for predicting pancreatitis after both diagnostic and therapeutic ERCP.