Value of serum lipase in early diagnosis of pancreatitis after ERCP
GONG Biyan1, ZENG Xia2, XIE Dan3, LIU Danqing4
1. General Surgery Department, 2. Out-Patient Department,Chongqing Municipal Corps Hospital of Chinese People's Armed Police Force,Chongqing 400061,China; 3. Department of Medical Insurance, the Fifth People's Hospital,Chongqing 400062,China; 4. Minimally Invasive Center for Hepatobiliary and Pancreatic Surgery, the First Hospital Affiliated to PLA Army Military Medical University, Chongqing 400038,China
Abstract：Objective To explore the value of serum lipase in the early diagnosis of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). Methods A retrospective analysis was performed on 3190 patients who underwent ERCP in Chongqing Municipal Corps Hospital of Chinese People's Armed Police Force and PLA Army Military Medical University from March 2017 to March 2020 to compare the AUC area under the ROC curve of serum lipase (S-Lip)and amylase (S-Amy), the threshold values of the ROC curve for early diagnosis of PEP, and the attributes of these values in the early diagnosis of pancreatitis after ERCP surgery(sensitivity, specificity, positive predictive value and negative predictive value). Results Among the 802 cases included in the study, 56 cases (6.9%) of ERCP postoperative pancreatitis occurred, including 30 cases (53.6%) at 3 h after ERCP and 26 cases (46.4%) at 24 h after ERCP. The AUC of S-Lip and S-Amy were 0.93 (95% confidence interval, 0.87-0.96) and 0.865 (95%CI, 0.78-0.90) at 3 hours after ERCP, and the differences were statistically significant (P<0.01). ROC curve showed that the optimal threshold value were 382 U/L for s-Lip(sensitivity 0.88,specificity 0.89,PPV 0.502,NPV 0.985)and 228 U/L for s-Amy(sensitivity 0.82,specificity 0.78,PPV 0.363,NPV 0.977). Conclusions Serum lipase is characterized by high sensitivity and specificity in the early diagnosis of PEP, and its early detection value after ERCP provides an important basis for the early intervention of PEP.
龚必焱, 曾霞, 谢丹, 刘丹清. 血清脂肪酶在ERCP术后胰腺炎早期诊断中的价值[J]. 武警医学, 2024, 35(8): 681-684.
GONG Biyan, ZENG Xia, XIE Dan, LIU Danqing. Value of serum lipase in early diagnosis of pancreatitis after ERCP. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(8): 681-684.
Pekgöz M. Post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review for prevention and treatment[J]. World J Gastroenterol, 2019, 25(29) : 4019-4042.
[2]
Langerth A, Isaksson B, Karlson B M, et al. ERCP-related perforations: a population-based study of incidence, mortality, and risk factors[J]. Surg Endosc, 2020, 34(5) :1939-1947.
[3]
Vissers R J, Abu-Laban R B, McHugh D F. Amylase and lipase in the emergency department evaluation of acute pancreatitis [J]. Emerg Med, 1999, 17(6) :1027-1037.
[4]
Srivastava R P, Nietert P J, Bobo J F G, et al.Serum amylase as a biomarker for proof-of-concept studies in post endoscopic retrograde cholangiopancreatography pancreatitis prevention[J]. Clin Gastroenterol Hepatol, 2023, 21(10) :2676-2678.
[5]
Szatmary P, Grammatikopoulos T, Cai W, et al. Acute pancreatitis: diagnosis and treatment[J]. Drugs, 2022, 82(12) :1251-1276.
[6]
Ismail O Z, Bhayana V. Lipase or amylase for the diagnosis of acute pancreatitis? [J] . Clin Biochem, 2017, 50(18) :1275-1280.
[7]
Smeets X, Bouhouch N, Buxbaum J, et al. The revised Atlanta criteria more accurately reflect severity of post-ERCP pancreatitis compared to the consensus criteria[J]. United European Gastroenterol, 2019, 7(4):557-564.
[8]
Cotton P B, Lehman G, Vennes J, et al.Endoscopic sphincterotomy complications and their management: an attempt at consensus[J]. Gastrointest Endosc, 1991, 37(3):383-393.
[9]
Banks P A, Bollen T L, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62(1):102-111.
[10]
Hirota M, Itoi T, Morizane T, et al.Postprocedure serum amylase or lipase levels predict postendoscopic retrograde cholangiopancreatography pancreatitis: Meta-analysis of diagnostic test accuracy studies and utility assessment[J/OL]. Dig Endosc, 2023.Nov 3.
Sabour S. Comment on “diagnostic value of serum amylase levels indicating computed tomography-defined post-endoscopic retrograde cholangiopancreatography pancreatitis”[J]. Pancreas, 2021,50(5):e52-e53.
[13]
Samanta A, Vadlapudi S S, Srivastava A, et al.Risk factors for post-endoscopic retrograde cholangio-pancreatography pancreatitis in children with chronic pancreatitis and its prediction using 4-hour postprocedure serum amylase and lipase levels[J]. Pancreas, 2024, 53(3):e247-e253.
2024, Vol. 35 
