Early prediction of post-ERCP pancreatitis by post-procedure amylase and lipase levels: A systematic review and meta-analysis

Abstract

Background and study aims Post-ERCP pancreatitis (PEP) is the most common complication attributed to the procedure, its incidence being approximately 9.7 %. Numerous studies have evaluated the predictive efficacy of post-procedure serum amylase and lipase levels but with varied procedure-to-test time intervals and cut-off values. The aim of this meta-analysis was to present pooled data from available studies to compare the predictive accuracies of serum amylase and lipase for PEP. Patients and methods A total of 18 studies were identified after a comprehensive search of various databases until June 2021 that reported the use of pancreatic enzymes for PEP. Results The sample size consisted of 11,790 ERCPs, of which PEP occurred in 764 (6.48 %). Subgroups for serum lipase and amylase were created based on the cut-off used for diagnosing PEP, and meta-analysis was done for each subgroup. Results showed that serum lipase more than three to four times the upper limit of normal (ULN) performed within 2 to 4 hours of ERCP had the highest pooled sensitivity (92 %) for PEP. Amylase level more than five to six times the ULN was the most specific serum marker with a pooled specificity of 93 %. Conclusions Our analysis indicates that a lipase level less than three times the ULN within 2 to 4 hours of ERCP can be used as a good predictor to rule out PEP when used as an adjunct to patient clinical presentation. Multicenter randomized controlled trials using lipase and amylase are warranted to further evaluate their PEP predictive accuracy, especially in high-risk patients.

Pediatric ERCP: Factors for Success and Complication—A 17-Year, Multisite Experience

“…The determination of PEP can be challenging, as many studies fail to discern whether they considered post-procedure pain and pancreatic enzyme elevation to be expected outcomes of pancreatic duct visualization (9). This is further confounded by the fact that pediatric ERCPs are increasingly performed in the outpatient setting, where the timing of serum amylase/lipase levels can vary from 2 to 24 hours after ERCP in symptomatic patients (16,17).…”

Predictors of Post-ERCP Pancreatitis (P.E.P.) in Choledochal Lithiasis Extraction

“…In recent years, blood tests have been used to predict pancreatic reactions after ERCP, but extensive studies have remained limited to amylase and lipase [ 5 , 6 , 7 ]. It has been found that some blood tests, which are not routinely collected, may also play a role in the occurrence of PEP-post-Endoscopic retrograde cholangiopancreatography pancreatitis [ 8 , 9 ].…”

Incidence and Predictors of Incidental Biochemical and Radiologic Pancreatic Alterations Following Uncomplicated ERCP

“…Despite these considerations, relatively little is known regarding the frequency with which alterations in biochemical and/or imaging parameters occur in asymptomatic patients following uncomplicated ERCP. Estimates of post-ERCP pancreatic enzyme increases within hours of the procedure are available [ 10 , 11 ], but estimates of the proportions of patients who experience alterations on routine measurement are scarce [ 12 ] and mainly confined to randomized trials, which may not represent real-world practices and generally do not have the ability to identify truly asymptomatic patients. Estimates of proportions of patients who are observed to have typical post-ERCP pancreatic imaging findings in the absence of adverse events are altogether absent.…”