Amylase quantification in the terminal Ileum following formation of an Ileostomy

Abstract

Amylase is elevated in the foregut and has been used to confirm anastomotic integrity after pancreatic surgery. The physiological activity of pancreatic enzymes in the ileum has been studied in healthy volunteers but not quantitated with the simple and readily available amylase measurements employed with serum tests. We aim to quantitate the levels of amylase in the terminal ileum. This was a prospective, non-randomised, non-blinded, consecutive cohort study conducted at the Royal Brisbane and Women’s Hospital. Consecutive patients undergoing routine surgery with an ileostomy were invited to participate in the study. Ileostomy effluent was collected and analysed daily for the first 5 post-operative days. This validation cohort included 8 males and 3 females, with a mean age of 49 years. Median daily amylase levels ranged from 4470 U/L to 23,000 U/L, with no specimens falling within the laboratory serum reference range of 40 to 130 U/L. Two specimens were not available on day one post-operative due to complete ileus. The sample size of 11 patients is small but was considered sufficient given that 55 effluent specimens were anticipated for analysis. Amylase levels remain highly elevated as the enzyme transits through the length of the small intestine and measured in the terminal ileum, and can be readily quantitated by the existing testing methodology routinely available.

Multicenter Study of Drain Fluid Amylase as a Biomarker for the Detection of Anastomotic Leakage After Ileal Pouch Surgery Without a Diverting Ileostomy

“…8 A study from our institution measured luminal amylase levels from newly created ileostomies and found the contents of the distal small intestine to be very high in this enzyme (median levels of 4470 to 23,000 U/L at postoperative days 1 to 5). 9 A subsequent pilot study from our institution assessed drain fluid amylase (DFA) in 13 patients undergoing restorative proctectomy (RP) with an ileal pouch. 8 There was a significant rise in DFA on the day of AL in the 2 patients who experienced an AL (p = 0.03).…”

“…A study from our institution measured luminal amylase levels from newly created ileostomies and found the contents of the distal small intestine to be very high in this enzyme (median levels of 4470 to 23,000 U/L at postoperative days 1 to 5). 9…”

Does an ileostomy cover the surgeon or the anastomosis?

“…The measurement of drain fluid amylase or drain fluid Gastrografin may achieve this end and there is emerging evidence of their utility as sensitive BMs for early AL. [17][18][19][20][21] Patients without a TDI are likely to present more dramatically and earlier in their post-operative recovery.…”

“…With omitting a TDI comes an imperative to identify AL at its earliest stage and address its management aggressively. The measurement of drain fluid amylase or drain fluid Gastrografin may achieve this end and there is emerging evidence of their utility as sensitive BMs for early AL 17–21 . Patients without a TDI are likely to present more dramatically and earlier in their post‐operative recovery.…”

An umbrella systematic review of drain fluid analysis in colorectal surgery for the detection of anastomotic leak: Not yet ready to translate research studies into clinical practice

“…A pilot study of 13 ileal pouch patients suggested that drain fluid amylase might be a sensitive BM of AL [35]. The authors demonstrated high intra-luminal levels of amylase in the ileum [36] and considered peritoneal levels above the established serum reference range as indicative of AL. They set an amylase value of 130 U/L as their threshold.…”