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 18 January 2018

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News

Pain and high amylase levels as indicators of post-ERCP pancreatitis

Pain at 24 hours, associated with amylase levels greater than 5 times the upper normal limit, is the most reliable indicator of post-ERCP pancreatitis, according to a report in January's Gastrointestinal Endoscopy.

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A team from Milan and Zingonia, Italy determined the clinical findings and enzyme values consistent for clinical pancreatitis at 24 hours after ERCP.

The post-ERCP/sphincterotomy course of 1,185 procedures was recorded prospectively.

Patients were evaluated for pancreatic-type pain, white blood cell count, and serum amylase before and 24 hours after the procedure. Pain and amylase levels were also recorded 6 to 8 hours after the procedure.

The post-ERCP/sphincterotomy course of 1,185 procedures was recorded prospectively.
Gastrointest Endosc

A CT was performed in all patients with pain associated with amylase levels greater than 3 times normal. All patients were evaluated clinically at 48 hours.

The team found that pancreatic-type pain never occurred in cases with amylase levels lower than 3 times normal; it was significantly associated with amylase levels greater than 5 times normal, either six to eight hours, or 24 hours after the procedure.

Leukocytosis and CT findings consistent with pancreatitis were observed only in patients (42% and 30%, respectively) with 24-hour amylase levels greater than 5 times normal.

None of the 18 patients with pain at 24 hours and serum amylase lower than 5 times normal had symptoms that persisted at 48 hours. 42% of the 60 patients with pain at 24 hours and amylase higher than 5 times normal had 48-hour pain at 48 hours and hyperamylasemia.

Dr Pier Alberto Testoni concluded on behalf of the group, "Features consistent with clinical pancreatitis were present only among patients with pancreatic-type pain at 24 hours and amylase levels higher than 5 times normal. Additional follow-up is required for these patients."

Gastrointest Endosc 2001; 53: 33-9
23 January 2001

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