Original ArticlesPain at 24 hours associated with amylase levels greater than 5 times the upper normal limit as the most reliable indicator of post-ERCP pancreatitis☆,☆☆
Section snippets
Material and methods
The clinical course and amylase levels after 1185 consecutive endoscopic procedures on the major and minor duodenal papilla in 1020 patients over a 36-month period were evaluated. Endoscopic procedures were performed by the same endoscopist either in a university (559) or in a university-affiliated institution (626). Patient age ranged between 5 and 94 years. All procedures (biliary or pancreatic sphincterotomy, drainage procedures, and diagnostic ERCP) were included, whether successful or
Results
Postprocedural hyperamylasemia occurred in 452 cases (38.1%): 351 of 798 therapeutic procedures (44.0%); 83 of 312 diagnostic procedures (26.6%); and 18 of 75 unsuccessful procedures (24.0%). Unsuccessful procedures were those in which neither duct was cannulated. The overall number and percentage of procedures in which serum amylase values, measured 6 to 8 hours and 24 hours after, were normal, greater than 2 times, between 3 and 5 times, or greater than 5 times the upper normal limit, and the
Discussion
The definition of pancreatitis still remains a controversial issue in relation to post-ERCP/-sphincterotomy complications; the amplitude and duration of serum amylase rise and the occurrence of pancreatic-type pain are crucial points in the definition and grading of the pancreatic reactions.
The rise in serum pancreatic enzymes may vary considerably after ERCP and sphincterotomy without clinical significance. Hyperamylasemia occurs in about 70% of cases within 2 to 4 hours after endoscopic
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Reprint requests: Pier Alberto Testoni, MD, Division of Gastroenterology and Gastrointestinal Endoscopy, University Vita-Salute San Raffaele, IRCCS San Raffaele Hospital, Via Olgettina, 60 - 20132 Milano, Italy.
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Gastrointest Endosc 2001;53:33-9