Serum amylase and lipase levels for prediction of postendoscopic retrograde cholangiopancreatography pancreatitis

Abstract

Background: The aim of the present study was to assess 2- and 4-h postendoscopic retrograde cholangiopancreatography (ERCP) serum amylase and lipase levels for prediction of post-ERCP, pancreatitis (PEP), and their predictive cutoff values. Materials and Methods: In this cross-sectional study, we evaluated serum amylase and lipase levels before the procedure, 2 h and 4 h after the procedure, and in patients with persisting abdominal pain, 24 h afterward. A total of 300 adult patients who underwent ERCP procedures from March 2014 to June 2015 in referral hospital in Isfahan were studied. The receiver operating characteristic analysis was applied to determine the predictive score of amylase and lipase levels for PEP 2 and 4 h after ERCP. Results: The 2-h serum amylase cutoff values of 241 IU/L (normal range: 28-100 IU/L) had a very high negative predictive value (NPV) (98.7) but a poor positive predictive value (49.2) for prediction of PEP (area under curve AUC: 0.947; 95% confidence interval CI: 0.914-0.979). Based on our results, the patients might be considered for supportive therapy of PEP with the 4-h serum amylase above the cut point of 839.5 IU/L with a specificity of 95.1% (AUC: 0.978; 95% CI: 0.964-0.992). In addition, the 2- and 4-h serum lipase levels at cut points of 216 IU/L (AUC: 0.954; 95% CI: 0.931-0.977) and 656.5 IU/L (AUC: 0.966; 95% CI: 0.945-0.986) (normal value <60 IU/L), respectively, had the best sensitivity (97.1%) and high NPVs (99.6%) for exclusion of PEP. Conclusion: Measurements of serum amylase and lipase 2- and 4-h post-ERCP might be useful in prediction of PEP.