Hyperamylasemia is a common finding after endoscopic procedures on Vater's papilla (ERCP, EPT); in most cases it has no clinical significance. However, in some cases the enzymatic raise is associated with acute pancreatitis (1-7% of cases). Since in many institutions these endoscopic procedures are currently performed in day-hospital regimen, it seems useful to identify, as early as possible, which patients could develop a severe pancreatic reaction, in order to plan a prolonged follow-up and a therapeutic approach to reduce the risk of pancreatitis. In a prospective series of 71 consecutive patients who had undergone endoscopic sphincterotomy, serum amylase activity was measured in bloods drawn immediately before the procedure and after 2, 4, 8 and 24 hours ; tha data obtained at 2, 4 and 8 hours were therefore compared with those at 24 hours, in order to detect the time in which the peak of serum amylase is predictive for either severe pancreatic reaction or pancreatitis. Fifty out of the 71 subjects had hyperamylasemia (> 220 U/l) after the procedure during the follow-up period. In 11 subjects an amylase level higher than five times the normal range (suggestive for severe pancreatic reaction) still persisted 24 hours after the procedure; three patients showed clinical findings of acute oedematous pancreatitis (confirmed by CT scan). Only the rise in serum amylase activity in blood drawn after 8 hours appeared in our study significantly associated with persistent pancreatic reaction or pancreatitis (p = 0.0076). No cases with mild hyperamylasemia (lower than 5 times the normal range) at 8 hours developed at 24 hours severe pancreatic reaction. On the other hand, 8/17 (47%) patients with severe hyperamylasemia at 8 hours had reduced level of serum enzymes at 24 hours. In conclusion, in our study on endoscopic sphincterotomy, the amylase value obtained 8 hours after the procedure avoids the risk of underestimate a severe pancreatic reaction and could be used as a key-point for monitoring and for a specific treatment.
|Number of pages||1|
|Publication status||Published - 1996|
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