Serum Amylase Measured Four Hours After Endoscopic Sphincterotomy Is A Reliable Predictor of Postprocedure Pancreatitis

Abstract

Serum amylase assessment 4 h after ES minimizes the likelihood of underestimating the risk of postprocedure pancreatitis. It is therefore a reliable, cost-effective follow-up, particularly in outpatients.

Use of the laparoscopic–endoscopic approach, the so-called “rendezvous” technique, in cholecystocholedocholithiasis

“…These features have been proposed by us as the most reliable indicators of post-ERCP pancreatitis [25,26].…”

Rescue ERCP and insertion of a small-caliber pancreatic stent to prevent the evolution of severe post-ERCP pancreatitis: a case-controlled series

“…It must be emphasized, that routine reassessment of serum amylase levels at 8 and 24 h post procedure during 1-day hospitalization (which is currently our strategy) necessitates performance of such a rescue ERCP procedure. Sensitivity of amylase measurement in detecting pancreatitis or long-lasting severe hyperamylasemia was highest at 8 h. Moreover, more than two-thirds of cases of moderate or severe pancreatitis (all but one with CT-confirmed pancreatitis) occurred among patients whose 4-and 8-h amylasemia was higher than five times the upper normal limit [18]. Early detection of evolution of severe post-ERCP pancreatitis is of critical importance, since we are of the opinion that a time delay really matters in terms of risk of complications, but the therapeutic window is rather individual, depending on several host factors of the inflammatory response.…”

Incidence and clinical significance of hyperamylasemia after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions: a prospective and controlled study

“…Serum amylase and lipase levels were systematically deter− mined before and 8 and 24 h after the procedure, in accordance with previous published data [6,7], and patients were carefully monitored during the following 24 h for the appearance of sig− nificant abdominal pain requiring administration of analgesics. Hyperamylasemia was defined by serum amylase concentra− tions above the normal upper limit (104 UI/L) and levels higher than baseline 8 h after the procedure.…”

“…Acute pancreatitis is the most serious complication, with an overall incidence around 8 % [4,5], although transient asymptomatic hy− peramylasemia, usually unrecognized clinically, is a very common finding. The peak of plasma en− zyme elevation is usually observed 4 ± 8 h after the procedure [6,7]. Several technical and pa− tient−related factors, such as pancreatic duct opacification or a history of relapsing pancreati− tis, have been involved in the pathogenesis of post−ERCP hyperamylasemia and pancreatitis [7,8].…”

“…The peak of plasma en− zyme elevation is usually observed 4 ± 8 h after the procedure [6,7]. Several technical and pa− tient−related factors, such as pancreatic duct opacification or a history of relapsing pancreati− tis, have been involved in the pathogenesis of post−ERCP hyperamylasemia and pancreatitis [7,8]. Endoscopic ultrasound−guided fine−needle as− piration (EUS−FNA) has been demonstrated to be an effective and safe technique for tissue diagno− sis in patients with pancreatic lesions [9 ± 14].…”