Serum lipase as a biomarker for early prediction and diagnosis of post-endoscopic retrograde cholangiopancreatography pancreatitis
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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.
KeywordsAmylase Diagnosing Lipase Pancreatitis Post-ERCP ROC
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.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in this study involving human participants were in accordance with the ethical standards of institutional research committee and with the 1964 Helsinki declaration and its later amendments.
- 6.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 CrossRefPubMedGoogle Scholar
- 7.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 CrossRefGoogle Scholar
- 8.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 CrossRefPubMedGoogle Scholar
- 15.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 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.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 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.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 CrossRefPubMedGoogle Scholar
- 21.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 CrossRefPubMedGoogle Scholar
- 25.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
- 27.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 CrossRefPubMedGoogle Scholar
- 29.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 CrossRefPubMedGoogle Scholar
- 31.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