Comparison of lipase and amylase for diagnosing post‐operative pancreatic fistulae

Abstract

Our experience suggests drain fluid amylase or lipase results are not sufficiently sensitive or specific to reassure clinicians and rule out clinically significant POPF. However, if biochemical tests are used to aid decision-making, then lipase is a more sensitive biochemical marker than amylase for the routine detection of clinically significant POPF.

Drain Amylase or Lipase for the Detection of POPF—Adding Evidence to an Ongoing Discussion

“…The authors proposed that drain fluid analysis is not sufficiently sensitive and specific to exclude CR-POPF. Nevertheless, they assumed that lipase might be more sensitive as a biochemical marker for routine detection of CR-POPF [13].…”

“…Moreover, they observed that a lipase level of >1000 units/L predisposes for a worse clinical course and is suggestive of type B or C POPF [12]. Another publication even recommends lipase as the more sensitive biochemical marker for detection of CR-POPF [13]. We therefore compared the use of postoperative drainage fluid amylase and lipase concentration and their prognostic impact on the diagnosis of POPF in a large retrospective cohort.…”

Early recognition of clinically relevant postoperative pancreatic fistula: a systematic review

“…Only one study 22 described criteria for performing an invasive intervention for pancreatic fistula, causing an uncertain risk of bias in all other studies. In 14 studies the test variable was tested on or after postoperative day 3, causing a high [21][22][23]25,27,28,31,32,[34][35][36]41,42,44,45,47,48,52,56 or uncertain 26,30,46,57 risk of bias in all other studies. Concerning applicability, in 8 studies the test HPB…”

“…Proposed cut-off values ranged from 90 to 10.000 U/l. [21][22][23]25,[28][29][30]34,36,37,39,40,42,44,45,50,52,53,55,56 Elevated serum amylase was reported in 5 different studies (1869 patients) was measured on weighted meanpostoperative day 1. Proposed optimal cut-off values ranged from 54 to 292 U/l.…”

“…Proposed cut-off values ranged from 180 to 1.000 U/l. 30,34 Elevated white blood cell count (WBC) was reported in 2 studies (300 patients) and was measured on weighted mean postoperative day 3. Proposed cut-off values ranged from 7,4 to 9,8 × 10 9 /l.…”