A grey zone of hyperamylasemia following endoscopic retrograde cholangiopancreatography: follow-up and differential diagnosis from acute pancreatitis.
| Autor: | Cakir M; Department of General Surgery, Istanbul Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey., Hut A; Department of General Surgery, Istanbul Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey., Akturk OM; Department of General Surgery, Istanbul Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey., Biçkici BE; Department of General Surgery, Istanbul Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey., Yildirim D; Department of General Surgery, Istanbul Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey. |
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| Jazyk: | angličtina |
| Zdroj: | Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques [Wideochir Inne Tech Maloinwazyjne] 2021 Mar; Vol. 16 (1), pp. 38-44. Date of Electronic Publication: 2020 Apr 18. |
| DOI: | 10.5114/wiitm.2020.94545 |
| Abstrakt: | 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 12 th and 24 th h (p < 0.001), amylase level at 12 th h (p < 0.001), C-reactive protein (CRP) levels at 6 th and 12 th h (p = 0.001 and p < 0.001), white blood cells (WBC) levels at 6 th and 12 th h (p = 0.001 and p < 0.001) were significant for development of PEP. CRP levels above 8 mg/l and WBC above 10 × 10 3 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 12 th h timepoint because insufflation during the procedure and other causes of abdominal pain may result in misinterpretation. Competing Interests: The authors declare no conflict of interest. (Copyright: © 2020 Fundacja Videochirurgii.) |
| Databáze: | MEDLINE |
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