A grey zone of hyperamylasemia following endoscopic retrograde cholangiopancreatography: Follow-up and differential diagnosis from acute pancreatitis
Wideochirurgia I Inne Techniki Maloinwazyjne, cilt.16, sa.1, ss.1-7, 2021 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 16 Sayı: 1
- Basım Tarihi: 2021
- Doi Numarası: 10.5114/wiitm.2020.94545
- Dergi Adı: Wideochirurgia I Inne Techniki Maloinwazyjne
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, EMBASE, Directory of Open Access Journals
- Sayfa Sayıları: ss.1-7
- Anahtar Kelimeler: acute pancreatitis, endoscopic retrograde cholangiopancreatography, hyperamylasemia
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a tool often used for treating and diagnosing pancreaticobiliary diseases. One of the important complications of ERCP is pancreatitis. Even though transient hyperamylasemia is a more common and benign situation, it must be distinguished from post-ERCP pancreatitis. Aim: To define the risk factors associated with post-ERCP pancreatitis (PEP) and tried to identify a cutoff about laboratory findings for positive or negative prediction. Material and methods: We reviewed the medical files of patients who underwent ERCP for choledocholithiasis in a retrospective cohort study. The primary outcome is the risk factors associated with PEP. Receiver operator characteristics analysis was carried out for determination of cut-offs for laboratory parameters. Results: The presence of cholangitis (p=0.018), Wirsung cannulation (p = 0.008), presence of abdominal pain at 12th and 24th h (p < 0.001), amylase level at 12th h (p < 0.001), C-reactive protein (CRP) levels at 6th and 12th h (p = 0.001 and p < 0.001), white blood cells (WBC) levels at 6th and 12th h (p = 0.001 and p < 0.001) were significant for development of PEP. CRP levels above 8 mg/l and WBC above 10 × 103 had negative predictive values over 70% and 90% respectively. Conclusions: Physical examination and inflammatory parameters are important in diagnosis of PEP. CRP and WBC have high negative predictivity and sensitivity. Amylase level increase was most apparent 12 h after ERCP and significantly higher (p < 0.001) for the development of PEP. The first abdominal pain evaluation is meaningful at the 12th h timepoint because insufflation during the procedure and other causes of abdominal pain may result in misinterpretation.