Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2016; 8(20): 777-784
Published online Dec 16, 2016. doi: 10.4253/wjge.v8.i20.777
Combination of two-hour post-endoscopic retrograde cholangiopancreatography amylase levels and cannulation times is useful for predicting post-endoscopic retrograde cholangiopancreatography pancreatitis
Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada
Shiro Hayashi, Tsutomu Nishida, Hiromi Shimakoshi, Akiyoshi Shimoda, Takahiro Amano, Aya Sugimoto, Kei Takahashi, Kaori Mukai, Tokuhiro Matsubara, Masashi Yamamoto, Sachiko Nakajima, Koji Fukui, Masami Inada, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
Author contributions: All authors contributed to this manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Toyonaka Municipal Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis retrospectively used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. However, this study was announced on the website at our hospital for a certain period and subjects who did not want to be used their data in this study were guaranteed the right to refuse.
Conflict-of-interest statement: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.
Data sharing statement: Dataset is available from the corresponding author at hayashishiro1976@yahoo.co.jp, when data sharing was anonymized and the project was approved by the Institutional Review Board of Toyonaka Municipal Hospital.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shiro Hayashi, MD, Department of Gastroenterology and Hepatology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka 560-8565, Japan. hayashishiro1976@yahoo.co.jp
Telephone: +81-6-68430101 Fax: +81-6-68583531
Received: June 29, 2016
Peer-review started: July 1, 2016
First decision: August 5, 2016
Revised: August 30, 2016
Accepted: September 21, 2016
Article in press: September 22, 2016
Published online: December 16, 2016
Processing time: 167 Days and 22.9 Hours
Abstract
AIM

To estimate the efficacy of 2 h post-endoscopic retrograde cholangiopancreatography (ERCP) serum amylase levels and other factors for predicting post-ERCP pancreatitis.

METHODS

This was a retrospective, single-center cohort study of consecutive patients who underwent ERCP from January 2010 to December 2013. Serum amylase levels were measured 2 h post-procedure, and patient- and procedure-related pancreatitis (PEP) risk factors were analyzed using a logistic model.

RESULTS

A total of 1520 cases (average age 72 ± 12 years, 60% male) were initially enrolled in this study, and 1403 cases (725 patients) were ultimately analyzed after the exclusion of 117 cases. Fifty-five of these cases developed PEP. We established a 2 h serum amylase cutoff level of two times the upper limit of normal for predicting PEP. Multivariate analysis revealed that a cannulation time of more than 13 min [odds ratio (OR) 2.28, 95%CI: 1.132-4.651, P = 0.0210] and 2 h amylase levels greater than the cutoff level (OR = 24.1, 95%CI: 11.56-57.13, P < 0.0001) were significant predictive factors for PEP. Forty-seven of the 55 patients who developed PEP exhibited 2 h amylase levels greater than the cutoff level (85%), and six of the remaining eight patients who developed PEP (75%) required longer cannulation times. Only 2 of the 1403 patients (0.14%) who developed PEP did not exhibit concerning 2 h amylase levels or require longer cannulation times.

CONCLUSION

These findings indicate that the combination of 2 h post-ERCP serum amylase levels and cannulation times represents a valuable marker for identifying patients at high risk for PEP.

Keywords: Serum amylase levels; Cannulation time; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Predictor

Core tip: Serum amylase levels have a high negative predictive value (NPV; 95%-100%) and have therefore previously been used to predict post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) to facilitate patient discharges. However, the positive predictive value (PPV) of serum amylase is highly variable (4%-62%); therefore, a more useful PEP predictor is needed. In this retrospective study, we identified useful predictive factors via multivariate analysis and the combination 2 h amylase levels and cannulation times. The 2 h amylase levels exhibited a good NPV (99%) and a poor PPV (22%) similar to those of previous reports but exhibited a sensitivity of only 86% with respect to PEP detection. However, the combined use of the above two variables increased the sensitivity to 96%; thus, this combination may enable clinicians to detect patients at high risk for PEP during the early phase of treatment.