Abstract
Background and Study Aims: Acute pancreatitis
is still the most common complication after endoscopic sphincterotomy (ES)
and cholangiopancreatography (ERCP). The aim of this study was to detect the
time when the peak of serum amylase was predictive for postprocedure pancreatitis
or long-lasting severe hyperamylasemia, in order to plan the follow-up of
patients.
Methods: Serum amylase activity was measured
in a prospective series of 409 consecutive patients after ES, immediately
before ES and two, four, eight and 24 hours thereafter; the two, four and
eight-hour data were compared with those at 24 hours and with the outcome.
Evaluation was done separately for the 198 cases with pancreatic duct opacification
and for the 202 cases at high risk for postprocedure pancreatitis.
Results: Twenty-four hours after ES, amylase
was still more than five times the upper normal limit in 26 patients, associated
with pancreatic-like pain in 19 of them (mild/moderate pancreatitis) and asymptomatic
in the remaining seven (long-lasting severe hyperamylasemia).
There was a significant difference at all sampling times between the 26 patients
with 24-hour severe hyperamylasemia and those with the lower level. Although
the sensitivity of amylase measurement in detecting pancreatitis was highest
at eight hours, in practice the four-hour assessment appears a reliable predictor.
Almost all patients with serum amylase levels more than five times the upper
normal limit at four, eight and 24 hours had had pancreatic duct opacification.
In contrast, patient-related risk factors for postprocedure pancreatitis did
not play a significant role in the present series.
Conclusions: Serum amylase assessment four
hours after ES is a reliable, cost-effective follow-up and minimizes the likelihood
of underestimating the risk of postprocedure pancreatic reaction. It should
be recommended particularly in out-patients and when pancreatic duct opacification
has occurred
