Acute pancreatitis is still the most common complication after endoscopic sphincterotomy (ES) and endoscopic retrograde choiangio-pancreatography (ERCP). The aim of this study was to detect the time when the peak of serum amylase was predictive for consistent hyperamylasemia or pancreatitis, in order to plan the follow-up of patients. Serum amylase activity was maesured in a prospective series of 409 consecutive patients after ES, immediately before ES and 2, 4, 8 and 24 hours thereafter; the 2, 4 and 8-hour data were compared with those at 24 hours and with the outcome. Evaluation was done separately for cases with pancreatic duct opacification and at high risk of post-procedure pancreatitis. Twenty-four hours after ES, amylase was still more than five times the upper normal llimiti in 26 patients, four of whom had mild acute pancreatitis. There was a significant difference (p = 0.01 at 2 hrs; p <0.001 at 4 and 8 hrs) between the 26 patients with 24-hour hyperamylasemia higher than five times the upper normal limit and those with lower levels. Although sensitivity and the positive and negative predicting values of amylase measurement in detecting severe hyperamylasemia or pancreatitis were highest at 8 hours, the 4-hour assessment appears a reliable predictor in practice. Almost all the patients with serum amylase levels more than five times the upper normal limit at 4 and 8 hours had had pancreatic duct opacification. In conclusion, serum amylase assessment 4 hours after ES is a reliable, cost-effective follow-up and minimizes the likelyhood of under-estimating the risk of post-operative pancreatic reaction; it should be recommended particularly in outpatients.
|Publication status||Published - 1998|
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