Prediction of pancreatitis following endoscopic retrograde cholangiopancreatography by the 4-h post procedure amylase level

Background: Pancreatitis is the commonest and most significant complication of endoscopic retrograde cholangiopancreatography (ERCP). Early detection of post-ERCP pancreatitis would allow the safe discharge of day-case patients and targeted use of preventive therapies. Clinical diagnosis is inaccurate, and the aim of this study was to evaluate the 4-h post-ERCP hyperamylasemia as a predictor of pancreatitis. Methods: Two hundred and sixty-three consecutive ERCPs performed at one center were prospectively analyzed, examining patient and procedure characteristics, as well as the amylase level as predictors of pancreatitis. Results: Younger age (< 25 years), Sphincter of Oddi dysfunction, pancreatogram and failed cannulation were risk factors for pancreatitis; sphincterotomy conferred an increased risk, which was not statistically significant. Hyperamylasemia was a highly sensitive and moderately specific predictor of pancreatitis. A cut-off level of 1.5-fold higher than normal was useful for the exclusion of pancreatitis, while a cut-off level of threefold higher than normal was more specific, so as to target potential preventive therapies. Conclusions: The 4-h post-ERCP amylase level is a useful test to base management decisions on. It needs to be interpreted in conjunction with clinical assessment as well as identifiable risk factors related to the patient or the procedure.