Lipase is one of the diagnostic criteria for acute pancreatitis; however, the value of serum lipase in the early prediction and diagnosis for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis remains controversial.
We evaluate the 3-h post-ERCP serum amylase and lipase activities for early prediction of postoperative pancreatitis (PEP) and compare the 24-h post-ERCP serum amylase and lipase activities in the diagnosis of PEP.
Clinical information of patients who underwent ERCP from January 2017 to December 2018 at our hospital were retrospectively reviewed. Receiver operating characteristic (ROC) curves were performed for 3-h and 24-h post-ERCP serum amylase and lipase activities to evaluate predictive and diagnostic values, respectively.
A total of 498 cases with ERCP were finally enrolled, in which 36 cases of PEP were confirmed. ROC curves for 3-h post-ERCP amylase and lipase activities depicted areas under the curve (AUCs) of 0.88 (P < 0.001, 95% confidence intervals [CI] 0.82–0.93) and 0.90 (P < 0.001, 95% CI 0.86–0.93), respectively. The difference showed no significance using Z test (Z = 0.69, P > 0.05). AUCs for 24-h amylase and lipase activities were 0.83 (P < 0.001, 95% CI 0.77–0.89) and 0.94 (P < 0.001, 95% CI 0.90–0.99), respectively, and the difference was significant (Z = 3.04, P < 0.05).
For early prediction of PEP, 3-h post-ERCP serum lipase activity is at least as good as that of amylase. For diagnosis of PEP, 24-h post-ERCP serum lipase is a much better indicator than that of amylase. Together, this study suggests that serum lipase should be given priority in the early prediction and diagnosis of PEP.
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Tryliskyy Y, Bryce GJ (2018) Post-ERCP pancreatitis: pathophysiology, early identification and risk stratification. Adv Clin Exp Med 27:149–154. https://doi.org/10.17219/acem/66773
Kochar B, Akshintala VS, Afghani E et al (2015) Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc 81:143–149.e9. https://doi.org/10.1016/j.gie.2014.06.045
Parekh PJ, Majithia R, Sikka SK, Baron TH (2017) The “scope” of post-ERCP pancreatitis. Mayo Clin Proc 92:434–448. https://doi.org/10.1016/j.mayocp.2016.10.028
Shih HY, Hsu WH, Kuo CH (2019) Postendoscopic retrograde cholangiopancreatography pancreatitis. Kaohsiung J Med Sci 35:195–201. https://doi.org/10.1002/kjm2.12040
Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RCG, Meyers WC, Liguory C, Nickl N (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37:383–393. https://doi.org/10.1016/S0016-5107(91)70740-2
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS, Acute Pancreatitis Classification Working Group (2013) Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 62:102–111. https://doi.org/10.1136/gutjnl-2012-302779
Artifon EL, Chu A, Freeman M et al (2010) A comparison of the consensus and clinical definitions of pancreatitis with a proposal to redefine post-endoscopic retrograde cholangiopancreatography pancreatitis. Pancreas 2010 39:530–535. https://doi.org/10.1097/MPA.0b013e3181c306c0
Mann DV, Kalu P, Foulds S, Edwards R, Glazer G (2001) Neutrophil activation and hyperamylasaemia after endoscopic retrograde cholangiopancreatography: potential role for the leukocyte in the pathogenesis of acute pancreatitis. Endoscopy 33:448–453. https://doi.org/10.1055/s-2001-14260
Freeman ML, Guda NM (2004) Prevention of post-ERCP pancreatitis: a comprehensive review. Gastrointest Endosc 59:845–864. https://doi.org/10.1016/S0016-5107(04)00353-0
Testoni PA, Caporuscio S, Bagnolo F, Lella F (1999) Twenty-four-hour serum amylase predicting pancreatic reaction after endoscopic sphincterotomy. Endoscopy 31:131–136. https://doi.org/10.1055/s-1999-13660
Testoni PA, Bagnolo F, Caporuscio S, Lella F (1998) Serum amylase measured four hours after endoscopic sphincterotomy is a reliable predictor of postprocedure pancreatitis. Am J Gastroenterol 94:1235–1241. https://doi.org/10.1111/j.1572-0241.1999.01072.x
Thomas PR, Sengupta S (2001) Prediction of pancreatitis following endoscopic retrograde cholangiopancreatography by the 4-h post procedure amylase level. J Gastroenterol Hepatol 16:923–926. https://doi.org/10.1046/j.1440-1746.2001.02547.x
Ito K, Fujita N, Noda Y, Kobayashi G et al (2007) Relationship between post-ERCP pancreatitis and the change of serum amylase level after the procedure. World J Gastroenterol 13:3855–3860
Sutton VR, Hong MK, Thomas PR (2011) Using the 4-hour post-ERCP amylase level to predict post-ERCP pancreatitis. JOP 12:372–376
Lee YK, Yang MJ, Kim SS, Noh CK, Cho HJ, Lim SG, Hwang JC, Yoo BM, Kim JH (2017) Prediction of post-endoscopic retrograde cholangiopancreatography pancreatitis using 4-hour post-endoscopic retrograde cholangiopancreatography serum amylase and lipase levels. J Korean Med Sci 32:1814–1819. https://doi.org/10.3346/jkms.2017.32.11.1814
Minakari M, Sebghatollahi V, Sattari M, Fahami E (2018) Serum amylase and lipase levels for prediction of postendoscopic retrograde cholangiopancreatography pancreatitis. J Res Med Sci 23:54. https://doi.org/10.4103/jrms.JRMS_1100_17
Papachristos A, Howard T, Thomson BN, Thomas PR (2016) Predicting post-endoscopic retrograde cholangiopancreatography pancreatitis using the 4-h serum lipase level. ANZ J Surg 88:82–86. https://doi.org/10.1111/ans.13665
Elmunzer BJ, Scheiman JM, Lehman GA, Chak A, Mosler P, Higgins PD, Hayward RA, Romagnuolo J, Elta GH, Sherman S, Waljee AK, Repaka A, Atkinson MR, Cote GA, Kwon RS, McHenry L, Piraka CR, Wamsteker EJ, Watkins JL, Korsnes SJ, Schmidt SE, Turner SM, Nicholson S, Fogel EL, U.S. Cooperative for Outcomes Research in Endoscopy (USCORE) (2012) A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med 366:1414–1422. https://doi.org/10.1056/NEJMoa1111103
Akbar A, Abu Dayyeh BK, Baron TH, Wang Z, Altayar O, Murad MH (2013) Rectal nonsteroidal anti-inflammatory drugs are superior to pancreatic duct stents in preventing pancreatitis after endoscopic retrograde cholangiopancreatography: a network meta-analysis. Clin Gastroenterol Hepatol 11:778–783. https://doi.org/10.1016/j.cgh.2012.12.043
Sun HL, Han B, Zhai HP, Cheng XH, Ma K (2014) Rectal NSAIDs for the prevention of post-ERCP pancreatitis: a meta-analysis of randomized controlled trials. Surgeon 12:141–147. https://doi.org/10.1016/j.surge.2013.10.010
Patai Á, Solymosi N, Mohácsi L, Patai ÁV (2017) Indomethacin and diclofenac in the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis of prospective controlled trials. Gastrointest Endosc 85:1144–1456.e1. https://doi.org/10.1016/j.gie.2017.01.033
Greiner M, Pfeiffer D, Smith RD (2000) Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Prev Vet Med 45:23–41. https://doi.org/10.1016/s0167-5877(00)00115-x
Hoo ZH, Candlish J, Teare D (2017) What is an ROC curve? Emerg Med J 34:357–359. https://doi.org/10.1136/emermed-2017-206735
Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 148:839–843. https://doi.org/10.1148/radiology.148.3.6878708
Rustagi T, Jamidar PA (2015) Endoscopic retrograde cholangiopancreatography-related adverse events: general overview. Gastrointest Endosc Clin N Am 25:97–106. doi: https://doi.org/10.1016/j.giec.2014.09.005
Mehnert CS, Graessler J, Kamvissi-Lorenz V et al (2014) Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) guideline – updated June 2014. Endoscopy 46:799–815. https://doi.org/10.1055/s-0034-1377875
Mine T, Morizane T, Kawaguchi Y, Akashi R, Hanada K, Ito T, Kanno A, Kida M, Miyagawa H, Yamaguchi T, Mayumi T, Takeyama Y, Shimosegawa T (2017) Clinical practice guideline for post-ERCP pancreatitis. J Gastroenterol 52:1013–1022. https://doi.org/10.1007/s00535-017-1359-5
ASGE Standards of Practice Committee, Chandrasekhara V, Khashab MA et al (2017) Adverse events associated with ERCP. Gastrointest Endosc 85:32–47. https://doi.org/10.1016/j.gie.2016.06.051
Tomoda T, Kato H, Ueki T et al (2019) Combination of diclofenac and sublingual nitrates is superior to diclofenac alone in preventing pancreatitis after endoscopic retrograde cholangiopancreatography. Gastroenterology 156:1753–1760.e1. https://doi.org/10.1053/j.gastro.2019.01.267
Ogura T, Imoto A, Okuda A, Fukunishi S, Higuchi K (2019) Can Iodixanol prevent post-endoscopic retrograde cholangiopancreatography pancreatitis? A prospective, randomized, controlled trial. Dig Dis 37:255–261. https://doi.org/10.1159/000496349
Kamal A, Akshintala VS, Talukdar R, Goenka MK, Kochhar R, Lakhtakia S, Ramchandani MK, Sinha S, Goud R, Rai VK, Tandan M, Gupta R, Elmunzer BJ, Ngamruengphong S, Kumbhari V, Khashab MA, Kalloo AN, Reddy DN, Singh VK (2019) A randomized trial of topical epinephrine and rectal indomethacin for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients. Am J Gastroenterol 114:339–347. https://doi.org/10.14309/ajg.0000000000000049
Yadav D, Agarwal N, Pitchumoni CS (2002) A critical evaluation of laboratory tests in acute pancreatitis. Am J Gastroenterol 97:1309–1318. https://doi.org/10.1111/j.1572-0241.2002.05766.x
Yinan S, Zhouchong W, Tian Y et al (2015) Japanese guidelines for the management of acute pancreatitis: Japanese guidelines 2015. J Hepatobiliary Pancreat Sci 22:405–432. https://doi.org/10.1002/jhbp.259
Gumaste V, Dave P, Sereny G (1992) Serum lipase: a better test to diagnose acute alcoholic pancreatitis. Am J Med 92:239–242. https://doi.org/10.1016/0002-9343(92)90070-R
Akhtar A, Sarode R, Agrawal D (2017) Measuring both serum amylase and lipase for acute pancreatitis lowers quality and raises cost. Cleve Clin J Med 84:670–672. https://doi.org/10.3949/ccjm.84a.16103
Sharma A, Masood U, Khan B, Chawla K, Manocha D (2017) Pancreatitis with normal lipase and amylase in setting of end-stage renal disease. Am J Emerg Med 35:1387.e3–1387.e4. https://doi.org/10.1016/j.ajem.2017.07.014
We thank the patients involved in this study and the support from the Department of Gastroenterology, Renmin Hospital of Wuhan University. We thank many online databases and resources for providing data and tools.
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Zhang, Y., Ye, X., Wan, X. et al. Serum lipase as a biomarker for early prediction and diagnosis of post-endoscopic retrograde cholangiopancreatography pancreatitis. Ir J Med Sci 189, 163–170 (2020). https://doi.org/10.1007/s11845-019-02089-2