Does Drainage Fluid Amylase Reflect Pancreatic Leakage after Pancreaticoduodenectomy?

Abstract

This study tried to determine if drainage fluid amylase reflects pancreatic leakage after pancreaticoduodenectomy and to determine the factors affecting the drainage amylase level. Patients undergoing pancreaticoduodenectomy were recruited. The drainage amylase was measured from postoperative day (POD) 1 to POD 7. Direct evidence of pancreatic leakage was provided by upper gastrointestinal studies using a water-soluble contrast medium and methylene blue dye in the pancreaticogastrostomy group or by pancreaticography with injected contrast medium via an exteriorized pancreatic stent in the pancreaticojejunostomy group on POD 7. A total of 37 patients were recruited. The drainage amylase level was higher than the normal serum amylase (>or= 190 U/L) in more than half of the cases on the initial POD 2 specimen, with a median of 745 U/L on POD 1 and 663 U/L on POD 2. The drainage amylase level was more than three times the normal serum amylase level (>or= 190 x 3 U/L) in 56.8% on POD 1, in 51.4% on POD 2, and in nearly one-third on POD 7 (29.7%). However, no pancreatic leakage occurred in any of the patients with a drainage amylase of >or= 190 U/L. Only one case of pancreatic leakage with a small amount of drainage fluid (10 ml) and low amylase level (74 U/L), was noted. Soft pancreatic parenchyma and a nondilated pancreatic duct were significantly associated with higher drainage amylase levels. In conclusion, biochemical leakage defined by amylase-rich drainage fluid might have no clinical significance and was not necessarily clinical pancreatic leakage following pancreaticoduodenectomy.

A Soft Pancreatic Remnant is Associated with Increased Drain Fluid Pancreatic Amylase and Serum CRP Levels Following Pancreatoduodenectomy

“…19 According to this report, drainage fluid total amylase was significantly higher in the group with a soft pancreatic parenchyma than in the group with a hard pancreatic parenchyma on POD 1-7. The results of the current study were similar to that report.…”

“…6,13,17 However, to our knowledge, there have been few detailed comparative studies between patients with a soft pancreatic texture and those with a hard pancreatic texture undergoing PD. Shyr et al 19 reported that a soft pancreatic parenchyma was associated significantly with higher drainage fluid amylase levels than a fibrotic pancreas in patients after PD. The aims of this prospective study were to clarify differences in postoperative changes of serum or drainage fluid pancreatic amylase levels and Creactive protein (CRP) levels between patients with a soft pancreatic texture and those with a hard pancreatic texture undergoing PD.…”

Risk Factors for Post-Pancreaticoduodenectomy Bleeding and Finding an Innovative Approach to Treatment

“…To provide direct evidence of pancreatic anastomosis leakage, upper gastrointestinal studies (oral intake of 2 ml of methylene blue dye plus 200 ml of water) or a fistulogram were performed in cases in which pancreatic leakage were suspected. Pancreatic leakage was defined as a leak of methylene blue dye into a drain or positive fistulogram findings during the postoperative period [4, 22]. Pancreas texture was determined by gross examination and significant fibrotic change by microscopic examination.…”

Spezielle Gesichtspunkte postoperativer Komplikationen in der Viszeralchirurgie

“…Ihre Häufigkeit wird in der Literatur mit 2-38% angegeben. Diese große Spannbreite erklärt sich aus dem ganz unterschiedlichen z. T. sehr eng oder sehr weit gefassten Definitionen der Komplikation "Pankreasleckage" [26].…”