The value of elastase evaluation in comparison with amylase andlipase in prediction and diagnosis of post-ERCP pancreatitis

. Kokozidis G, Kinigopoulou P., Kapetanos D., Paikos D., Papaioannou A., Progia E., Kitis G.

Authors . Kokozidis G, Kinigopoulou P., Kapetanos D., Paikos D., Papaioannou A., Progia E., Kitis G..

Abstract

Pancreatitis is the most common of the serious complications
of ERCP, with rates between 2 and 40%. The aim of
this study was to evaluate the significance of serum levels
of amylase, lipase and elastase after ERCP, in the prediction
and diagnosis of pancreatitis.
Patients: Forty three consecutive patients underwent ERCP
for various indications.
Methods: Serum samples were taken before, one hour and
six hours after the procedure. Amylase was evaluated with
enzymatic colourimetric test (Olympus, normal<200 U/L),
lipase with kinetic ultraviolet method (Boehringer, normal<
190 U/L) and elastase with ELISA (Schebo Tech, normal<
3,5 ng/ml).
Results: Two patients (4%) developed mild pancreatitis and
one (2%) had fever for 48 hours. The others had normal
course. Nineteen patients (44%) had serum amylase elevation
(>2N) the first hour and 26 (60%) the sixth. Twenty
seven (62%) had serum lipase elevation (>2N) the first hour
and 30 (70%) the sixth. Four (9%) had increased elastase
(>2N) the first hour and 2 (4%) the sixth. The only enzyme
that was significantly elevated in the patients who developed
pancreatitis compared to those who did not, was serum
elastase at one hour post-ERCP (p=0,025). In the first
hour, sensitivity for amylase, lipase and elastase was 50%,
100% and 100% respectively, specificity 60%, 40% and 95%,positive predictive value (PPV) 5%, 7% and 50% and negative
predictive value (NPV) 96%, 100% and 100%. In the
sixth hour sensitivity was 100%, 100% and 100%, specificity
40%, 30% and 98%, PPV 4%, 3% and 50% and NPV 100%,
100% and 100% respectively.
Conclusions: Although serum amylase and lipase evaluation
are good methods to exclude the diagnosis of pancreatitis,
they do not assist in prediction and documentation of
diagnosis. In contrast, serum elastase evaluation is more
reliable in prediction and diagnosis of post-ERCP pancreatitis.
Key words: ERCP, pancreatitis, amylase, lipase, elastase