engleski

SERUM AMYLASE LEVEL IS A RELIABLE PREDICTOR OF POST-ERCP PANCREATITIS AFTER ENDOBILIARY STENTING

INTRODUCTION: Acute pancreatitis is a frequent complication following sphincterotomy and biliary stenting. The aim of our study was to evaluate the usefulness of serum amylase levels and peak activity time, for prediction of onset and estimation of severity of pancreatitis, after biliary stent placement. AIMS & METHODS: We analysed 781 inpatients, in a tertiary care hospital, in whom were placed one or more biliary stents for various indications. Of these, 123 had pancreatic stents implanted in addition to biliary stents. Serum amylase levels were measured 6, 12 and 24 hours after stent placement. We studied the significance of the amount of increase in serum amylase levels and peak activity time on prediction of onset and estimation of the severity of pancreatitis. RESULTS: At 24 hours after biliary stenting, 71 patients had a seven-fold (or more) increase in serum amylase levels (9%), and 52 of those had mild/moderate pancreatitis (73 % ; or 6.6% of all 781 patients). Of those 52 who developed acute pancreatitis, 48 had the highest level of serum amylase at 6 hours after the procedure (92%). In three patients we had to remove the stents for a couple of days to enable the acute pancreatitis to improve. In the group of patients in whom were placed both biliary and pancreatic stents, only three had a seven-fold (or more) increase in serum amylase levels (2, 4%), and of those, only two developed mild/moderate pancreatitis (66% ; or 1, 6% of all 123 patients). CONCLUSION: Measuring serum amylase levels at 6 hours after ERCP may be a significant predictor of the onset of post-ERCP pancreatitis. In our study, preventative pancreatic stenting significantly reduced serum amylase levels and post-ERCP pancreatitis.

ERCP; post-ERCP pancreatitis; biliary stenting

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