硝酸甘油预防ERCP术后胰腺炎及高淀粉酶血症的临床应用研究

目的 探讨硝酸甘油对经内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)和高淀粉酶血症的预防作用.方法 选择2008年1～12月在山东省交通医院肝胆外科住院治疗、经CT或MRI证实为胆总管结石、拟实施ERCP、经内镜乳头括约肌切开术(EST)及经内镜取石的患者100例,按照随机数字表法随机分为硝酸甘油组(n=50)与对照组(n=50),检测2组患者术前、术后3 h和24 h血清淀粉酶水平以及术后高淀粉酶血症和PEP的发生情况.结果 2组患者术前血清淀粉酶水平的差异无统计学意义(P＞0.05),2组患者术后3 h和24 h血清淀粉酶水平均高于术前水平(P＜0.01),但硝酸甘油组术后3 h及24 h血清淀粉酶水平[(108.88±152.07) U/L,(97.02±113.38) U/L]均分别显著低于对照组术后3 h及24 h血清淀粉酶水平[(196.30±244.41) U/L,(234.22±406.05) U/L],P＜0.05.硝酸甘油组ERCP术后的高淀粉酶血症发生率(12.00%,6/50)和PEP发生率(2.00%,1/50)均分别显著低于对照组[高淀粉酶血症30.00%(15/50),PEP 14.00%(7/50)],P＜0.05.结论 舌下含化硝酸甘油可降低ERCP术后血清淀粉酶水平,对PEP及高淀粉酶血症均有预防作用.     

加贝酯联合奥曲肽对ERCP术后胰腺炎和高淀粉酶血症的预防效果

目的 探讨加贝酯联合奥曲肽对ERCP术后胰腺炎和高淀粉酶血症的临床预防效果。方法 以本院2013年10月至2014年10月收治的130例行ERCP术的患者为研究对象,随机分为观察组和对照组,每组各65例;两组均采取常规支持治疗,对照组在此基础上服用加贝酯,观察组在对照组基础上联用奥曲肽;比较两组患者胰腺炎和高淀粉酶血症发生率、患者治疗满意度和不良事件发生率等情况。结果 （1）观察组术后胰腺炎和术后6 h、12 h和24 h的高淀粉酶血症发生率低于对照组（P<0.05）;（2）观察组术后6 h、12 h 和24 h的血清淀粉酶水平低于对照组（P<0.05）;（3）观察组患者满意度优于对照组（P<0.05）;（4）观察组不良反应发生率为4.62%,低于对照组的18.04%（P<0.05）。结论 ERCP术后联用加贝酯和奥曲肽,能显著降低胰腺炎和高淀粉酶血症发生率,提高患者满意度,且不良反应少,具有临床推广意义。     

大承气汤保留灌肠预防ERCP术后胰腺炎和高淀粉酶血症

目的 研究大承气汤保留灌肠预防ERCP术后胰腺炎和高淀粉酶血症的临床效果。方法 对上海中医药大学附属普陀医院2019年5 月至2020年6 月收治的80例拟行ERCP术的患者进行前瞻性分析,通过随机分配法分成对照组（40 例）和大承气汤组（40 例）。大承气汤组术前2 h以及术后4 h均予以大承气汤150 mL（38～40 ℃）保留灌肠,手术和术后鼻胆管引流、抗感染及补液对症支持治疗与对照组相同。比较两组术后腹痛症状,ERCP术后胰腺炎和高淀粉酶血症发生例数,及术后24 h的血淀粉酶、白细胞、CRP、IL-10 水平。结果 术后大承气汤组与对照组血淀粉酶[（121.6±11.24）U/L vs （229.82±19.12）U/L]、IL-10[（111.62±3.57）pg/mL vs（ 49.12±0.92）pg/mL]、CRP[（7.54±0.67）mg/L vs（ 11.45±1.21）mg/L]、术后24 h腹痛评分[（4.05±0.87）分 vs（ 5.25±1.17）分]差异均有统计学意义（P＜0.05）;白细胞计数[（8.38±0.38）×10⁹/L vs（ 7.49±0.35）×10⁹/L]差异无统计学意义（P＞0.05）。大承气汤组发生ERCP术后胰腺炎2例（5%）,对照组4例（10%）,差异无统计学意义（P＞0.05）;大承气汤组发生术后高淀粉酶血症13例（32.5%）,对照组发生27 例（67.5%）,差异有统计学意义（P＜0.05）。结论 大承气汤保留灌肠能够降低ERCP术后高淀粉酶血症的发生率,减轻机体术后腹胀腹痛,降低机体炎症反应;但本研究没有足够证据证明大承气汤保留灌肠可以降低术后胰腺炎发生率。     

ERCP术后胰腺炎的防治

目的　探讨内窥镜逆行胰胆管造影 (ERCP)术后胰腺炎乌司他丁 (Ulinastatin,UTI)的防治作用。方法　对1 998年 1月～ 2 0 0 3年 3月我院住院行 ERCP术 1 6 4例病人作回顾性分析总结。结果　 1 6 4例行 ERCP术病人随机分为三组 :对照组 6 2例 ,乌司他丁组 6 8例 ,生长抑素组 34例。1 34例插管成功 ,成功率 82 .0 % ,其中胆管、胰管均显影 6 6例 ,胆管显影 4 6例 ,胰管显影 5 2例 ,在胆管显影的 1 1 2例中 ,70例总胆管有扩张 ,直径≥ 1 0 m m,4 2例总胆直径正常 <1 0 m m。预防用药组 ER-CP术后 2 h血清淀粉酶 (乌司他丁 2 2 6 .5± 2 6 2 .9U/ L,生长抑素 2 6 4 .0± 2 0 4 .5 U/ L)、2 4 h血清淀粉酶 (乌司他丁 2 92 .4±31 9.6 U/ L,生长抑素 2 82 .7± 2 93.8U/ L)明显低于对照组组 (5 2 2 .2± 4 96 .2 U/ L,5 0 6 .1± 5 5 9.8U/ L,P<0 .0 1 ) ;乌司他丁组、生长抑素组 ERCP术后 2 h、2 4 h血清淀粉酶水平亦明显高于术前水平 (P<0 .0 5 )。结论　乌司他丁通过减少胰液的分泌量和降低胰酶的浓度 ,能够有效防治 ERCP术后胰腺炎的发生     

吲哚美辛栓预防ERCP术后胰腺炎及高淀粉酶血症临床效果研究

目的观察并比较吲哚美辛栓预防经内镜逆行性胰胆管造影术(ERCP)后胰腺炎及高淀粉酶血症的临床效果。方法将2013年6月~2015年6月间本院内镜中心收治的204例接受ERCP诊治患者随机分为2组:吲哚美辛组于术前30min经直肠给与吲哚美辛栓剂100mg,对照组不予任何预防药物。检测所有患者术前、术后6h、12h、24 h血清淀粉酶水平,比较2组患者ERCP术后胰腺炎(PEP)和高淀粉酶血症发生率,观察不良反应。结果 2组患者ERCP术前血清淀粉酶均为正常值。术后6h、12h、24h血清淀粉酶水平与术前比较均升高,两组差异有统计学意义(P0.05)。吲哚美辛栓组、对照组PEP发生率分别为4.00%、18.37%,差异有统计学意义(χ~2=3.810,P0.05);吲哚美辛组、对照组ERCP术后高淀粉酶血症发生率分别为32.00%、55.10%,差异有统计学意义(χ~2=5.437,P0.05)。吲哚美辛组未出现严重不良反应。结论 ERCP术前预防性直肠应用吲哚美辛栓可有效降低PEP和高淀粉酶血症的发生率,且安全性好。     

生大黄预防ERCP术后胰腺炎的疗效观察

目的:观察生大黄对内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)及高淀粉酶血症的预防作用。方法:选择2012年10月—2013年10月共800例术前血清淀粉酶正常行ERCP患者,患者随机分为观察组和对照组,每组各400例,术后均予常规治疗外,观察组于ERCP术后口服生大黄浸泡液(1次/3h)至通便为止。比较两组术后相关临床指标。结果:与对照组比较,观察组PEP(2.0%vs.7.5%)、高淀粉酶血症(5.0%vs.16.3%)、术后腹痛发生率(15.0%vs.51.3%)发生率均明显降低(均P0.05),而且术后排便时间明显缩短(10.61hvs.19.51h)(P0.01)。结论:生大黄可降低PEP及高淀粉酶血症的发生率,减轻术后腹痛的发生率。     

EST治疗LC术后胆总管结石体会

目的 探讨腹腔镜下胆囊切除术(LC)后行内镜逆行胰胆管造影(ERCP)和内镜乳头括约肌切开术(EST)治疗胆总管结石的安全性和效果. 方法 对LC术后出现黄疸或胆管炎的56例胆总管结石患者,行ERCP明确诊断并利用EST取石. 结果 56例患者共取出结石72枚,3例第2次行ERCP并用气囊取石成功,术后患者均痊愈出院,复查B超无结石残存或胆管扩张. 结论 EST治疗胆囊切除术后胆总管结石,安全、无创、有效,是治疗LC术后胆总管结石的首选方法.     

ERCP所致急性胰腺炎的预防

目的 探索预防ERCP所致急性胰腺炎的有效方法. 方法 420例行ERCP惠者,随机分为实验组318例,对照组102例.实验组病人在ERCP术前、术中持续静滴甲磺酸加贝酯注射液,术后胆管内注入山莨菪碱注射液和硫酸庆大霉素注射液.对照组病人于ERCP后静滴山莨菪碱注射液10 mg.两组病人分别于术后第3,16小时取静脉血测定淀粉酶含量. 结果 实验组病人血淀粉酶的升高频次及程度明显低于对照组(P<0.01),急性胰腺炎的出现频次也低于对照组(P<0.05). 结论 ERCP病人在操作前、中持续静滴甲磺酸加贝酯注射液,术后胆管内注入山莨菪碱、庆大霉素注射液,能够明显降低ERCP后病人的血淀粉酶含量及急性胰腺炎的发生率.     

乌司他丁对幕上肿瘤切除术患者颈内静脉球部血清SOD和MDA含量的影响

目的 观测乌司他丁对幕上肿瘤切除术患者颈内静脉球部血清超氧化物歧化酶（SOD）、丙二醛（MDA）含量的影响。方法 择期行幕上肿瘤切除术患者24例,年龄18~55岁,ASAⅠ~Ⅱ级。随机数字表法分为对照组（A组,12例）、乌司他丁组（U组,12例）,U组在切皮时予2 kU/kg乌司他丁静脉推注,随后予1 kU·kg^-1·h^-1泵注至术毕。A组于相同一时点输入等量0.9%生理盐水。分别全麻诱导前（T₁）、切皮前（T₂）、切硬脑膜后1 h（T₃）、缝硬脑膜时（T₄）手术结束（T₅）、术后24 h（T₆）6个时点同步采集颈内静脉球部血,采用改良盐酸羟胺法和TAB荧光法测定SOD、MDA含量。结果 SOD活性T₃~T₆均较T₁显著下降（P<0.001）,MDA含量T₃~T₆均较T₁显著上升（P<0.001）,SOD活性U组T₃~T₆高于A组（P<0.001）,MDA含量U组T₃~T₆较 A组显著降低（P<0.001）。结论 乌司他丁能提高患者术中、术后24 h内血清SOD活性,降低MDA含量,抗脂质过氧化反应是其发挥脑保护作用的机制之一。     

单纯表面麻醉与静脉全身麻醉对经内镜逆行胰胆管造影术术后胰腺炎发生的影响

目的 探讨单纯表面麻醉与静脉全身麻醉对经内镜逆行胰胆管造影术(ERCP)术后胰腺炎发生的影响。方法 2021年1月～2023年3月间在我院收治的因胰胆管疾病行ERCP病人400例,分为单纯表面麻醉组和静脉全身麻醉组,每组各200例。记录两组病人术前及术后3小时、24小时静脉血清胰淀粉酶水平及腹部症状体征,观察两组病人术后3小时、24小时发生高淀粉酶血症和术后胰腺炎的情况。结果 单纯表面麻醉组ERCP术后胰腺炎的发生率为7.5%,静脉全身麻醉组为2.0%,两组比较差异有统计学意义(P<0.05);术后3小时静脉全身麻醉组血清胰淀粉酶水平为(198±216)U/L,单纯表面麻醉组为(379±327)U/L,两组比较差异有统计学意义(P<0.05);术后24小时,静脉全身麻醉组血清胰淀粉酶水平为(129±98)U/L,单纯表面麻醉组为(187±156)U/L,两组比较差异有统计学意义(P<0.05)。术后3小时静脉全身麻醉组高淀粉酶血症发生率为15.5%,单纯表面麻醉组为34.5%,术后24小时静脉全身麻醉组高淀粉酶血症发生率为为5.5%,单纯表面麻醉组为19.0%。两组比...     

基于血小板参数的酒精性肝硬化预测模型构建与评估

目的 构建血小板参数用于酒精性肝炎(alcoholic hepatitis,AH)转变为酒精性肝硬化(alcoholic cirrhosis,AC)的预测模型,并评估其预测价值.方法 回顾性分析2018年1月至2020年12月台州医院肝胆外科收治的首诊AH、AC患者共计60例,其中AH组与AC组各为30例,并收集同期健...     

Rectal NSAIDs for the prevention of post-ERCP pancreatitis: A meta-analysis of randomized controlled trials

Background and purposeAcute pancreatitis is the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP). We conducted a meta-analysis to evaluate the efficacy and safety of rectal nonsteroidal anti-inflammatory drugs (NSAIDs) for the prevention of post-ERCP pancreatitis (PEP).MethodsPubMed and Embase databases were searched through April 2013. Results are reported as relative risk (RR) or weighted mean difference (WMD) with 95% confidence interval (95% CI). The primary outcome measure was the incidence of PEP. Secondary outcome measures included the severity of PEP and serum amylase level 2 h, 24 h after ERCP.ResultsSeven trials containing 1846 patients were eligible. Rectal NSAIDs significantly reduced the incidence of PEP (RR 0.45, 95% CI 0.34–0.61, P < 0.001). The results were maintained in subsequent subgroup analysis. Rectal NSAIDs also was associated with a reduction in the incidence of mild PEP (RR 0.54, 95% CI 0.35–0.83, P = 0.005), moderate to severe PEP (RR 0.39, 95% CI 0.22–0.70, P = 0.002), or serum amylase level 2 h after ERCP (WMD ?91.09 IU/L, 95% CI ?149.78 to ?32.40, P = 0.002).ConclusionsRectal NSAIDs reduced the incidence and severity of PEP, as well as serum amylase level 2 h after ERCP.     

Validation of day 1 drain fluid amylase level for prediction of clinically relevant fistula after distal pancreatectomy using the NSQIP database

Background

The role of postoperative day 1 drain fluid amylase level in predicting clinically relevant postoperative pancreatic fistula is under investigation. In a previous multicenter study conducted on 338 patients undergoing distal pancreatectomy, day 1 drain fluid amylase level has been correlated to the development of a clinically relevant pancreatic fistula and an amylase value of 2,000 U/L was found to be most predictive of the development of clinically relevant postoperative pancreatic fistula. Our objective was to validate the previously established cutoff level for drain fluid amylase on postoperative day 1 after distal pancreatectomy as a predictor for clinically relevant postoperative pancreatic fistula using a different patient population from the National Surgery Quality Improvement Program database.

Evaluation of amylase and lipase in the diagnosis of acute pancreatitis

Background : The diagnosis of acute pancreatitis relies heavily on a raised amylase. Methods : In the present study patients were prospectively categorized, without knowledge of pancreatic enzyme levels, into acute pancreatitis (AP; n = 51), disease controls (n = 35), indeterminate as to pancreatitis (n = 189) or exclusions (non‐pancreatitis diseases where amylase may be elevated; n = 53). Results : Enzyme levels were analysed by receiver operator characteristics (ROC) curves, with specificity > 80%. Day 1 serum lipase gave the greatest diagnostic accuracy (area under ROC curve = 0.128; P = 0.041 vs serum amylase). At the calculated diagnostic threshold of 208 U/L, lipase gave a sensitivity of 67% and a specificity of 97%. Other diagnostic thresholds (day 1) were: serum total amylase, 176 U/L (ROC 0.104, sensitivity 45%, specificity 97%), urinary total amylase, 550 U/L (ROC 0.108, sensitivity 62%, specificity 97%) and serum pancreatic isoamylase, 41 U/L (ROC 0.107, sensitivity 63%, specificity 85%). At delayed diagnosis (3 days) no enzyme was superior to lipase. The combination of lipase and amylase did not increase diagnostic accuracy. Conclusion : Serum lipase is recommended for diagnosis of AP, both early and late in the disease. Although highly specific when elevated, all pancreatic enzymes have low sensitivity for diagnosis.     

Usefulness of Drain Amylase, Serum C-Reactive Protein Levels and Body Temperature to Predict Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

Background

Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a worrisome and life-threatening complication. Recently, early drain removal has been recommended as a means of preventing POPF. The present study sought to determine how to distinguish clinical POPF from non-clinical POPF in the early postoperative period after PD to aid in early drain removal.

Methods

From March 2002 through December 2010, 176 patients underwent PD and were enrolled in this study to examine factors predictive of clinical POPF after PD. POPF was defined and classified according to the International Study Group of Pancreatic Surgery guideline, and grade B/C POPF was defined as clinical POPF.

Results

Grade A POPF occurred in 39 (22.2 %) patients, grade B in 19 (10.8 %) patients, and grade C in 11 (6.3 %) patients. Clinical POPF (grade B/C) occurred in 17.1 % of patients. Multivariate analysis revealed male gender and body mass index (BMI) ≥22.5 kg/m² to be the independent preoperative risk factors predictive of POPF. Receiver operating characteristic curves showed that the combination of drain amylase ≥750 IU/L, C-reactive protein (CRP) ≥20 mg/dL, and body temperature ≥37.5 °C on postoperative day 3 could effectively distinguish clinical POPF from non-clinical POPF. Sensitivity, specificity, and accuracy were 84.6, 98.2, and 95.7 %, respectively.

Conclusions

Male gender and BMI ≥22.5 were the independent preoperative predictive risk factors for POPF. We assume that when amylase is <750 IU/L, serum CRP is <20 mg/dL, and body temperature is <37.5 °C the drain can safely be removed, even if POPF is indicated.     

Value of serum bicarbonate in prediction of the long-term prognosis of renal function after acute kidney injury

Objective To evaluate the value of serum bicarbonate concentration as a prognostic indicator of renal function by following up the renal function in the acute kidney injury (AKI) patients. Methods 169 cases of AKI patients were enrolled in the study. Clinical data were collected prospectively. Risk factors of the renal outcome were evaluated. The patients were followed up for average 19 months. Results The serum bicarbonate concentration on AKI (r=-0.302, P＜0.001), 3 months after AKI (r=-0.363, P＜0.363), and 6 months after AKI (r=-0.591, P＜0.001) were all negatively correlated with serum creatinine. Compared with renal function recovered group, the serum bicarbonate concentration of renal function unrecovered group on AKI (21.92 mol/L vs 24.58mol/L), 3 months after AKI (22.58 mol/L vs 25.54 mol/L), 6 months after AKI (21.89 mol/L vs 25.42 mol/L), 12 months after AKI (19.85 mol/L vs 24.07 mol/L) were all significantly decreased (all P＜0.05). When AKI occurred, the Scr, serum bicarbonate concentration, the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney, area under the receiver-operating characteristic (ROC) curves were 0.840, 0.667, 0.837, sensitivity were 68.6%, 51%, 80.4%, specificity were 88.9%, 80.9% and 73.6%, respectively. 3 months AKI after, the Scr, serum bicarbonate concentration, the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney, area under the ROC curves were 0.838, 0.732, 0.848, sensitivity was 83.3%、 69.2%、91.7%, specificity were 79.5%, 70.8% and 74.4%, respectively. 6 months the after AKI, Scr, serum bicarbonate concentration, the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney, area under the ROC curves were 0.948, 0.798, 0.952, sensitivity were 100%, 80%, 100%, specificity were 84%, 80% and 88%, respectively. Combined 3 time points of serum bicarbonate concentration when AKI occurred, 3 month and 6 months after AKI, the area under the ROC curve was 0.850, sensitivity was 85.7%, specificity was 84.2%. When combined 3 time points of the Scr levels of AKI occurred, 3 months and 6 months after AKI, area under the ROC curve was 0.940, sensitivity was 100%, specificity was 84.2%.When combined 3 time points of combined value of Scr levels and serum bicarbonate concentrations of AKI occurred, 3 months and 6 months after AKI, the area under the ROC curve was 0.962, sensitivity was 100% and specificity was 94.7%. The Kaplan-Meier survival curve analysis showed that the serum bicarbonate concentration on AKI＜21.65 mmol/L, serum bicarbonate concentration 3 months after AKI＜24.3 mmol/L or serum bicarbonate concentration 6 months after AKI＜23.5 mmol/L were all significantly correlated with poor renal prognosis. Conclusion Serum bicarbonate concentration is helpful to predict the renal ont come after AKI. Combination of serum bicarbonate concentrations and serum creatinine levels increased the accuracy of prediction.     

奥曲肽联合泮托拉唑预防内镜逆行胰胆管造影术后胰腺炎

目的：探讨内镜逆行胰胆管造影（ERCP）术后胰腺炎的预防措施。 方法：将2010年7月—2012年11月间行ERCP术后的患者100例,随机分为观察组和对照组,每组各50例患者。观察组术后给予联合应用生长抑素（奥曲肽0.1 mg/8 h皮下注射连用24 h）和质子泵抑制剂作预防治疗（泮托拉唑40 mg/d静脉滴注连用2 d）,对照组给予生理盐水静脉滴注。比较两组患者ERCP术后3,12,24 h的血清淀粉酶情况,及胰腺炎的发生情况。 结果：两组一般资料比较具有可比性;在术后3,12,24 h各时间点比较,观察组血清淀粉酶水平均明显低于对照组（均P<0.05）;观察组术后12,24 h高淀粉酶血症发生率及术后急性胰腺炎明显均低于对照组（18% vs. 42%;8% vs. 22%;2% vs. 16%）（均P<0.05）。 结论：联合应用生长抑素和质子泵抑制剂可减少ERCP术后高淀粉酶血症与胰腺炎的发生率,是一种安全且有效的ERCP术后胰腺炎预防措施。     

Value of serum IgG combined with IgE in predicting steroid therapy response in children with primary nephrotic syndrome

Objective To observe the value of serum IgG combined with IgE in the diagnosis of steroid-sensitive nephrotic syndrome (SSNS) children. Methods Children with primary nephrotic syndrome diagnosed in Beijing Children's Hospital affiliated to Capital Medical University from January 2018 to March 2019 were enrolled. According to the 4 weeks steroid therapy, the patients were divided into steroid sensitive group and steroid resistance group. The receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of serum IgG combined with IgE for SSNS. Results There were no significant differences in age, gender, course of the disease, hemoglobin, platelet, urea nitrogen, creatinine, albumin, globulin, 24 h urine protein, IgA level, IgM level and hematuria between steroid sensitive group and steroid resistance group (all P＞0.05). There were significant differences in C3, IgG and IgE levels (all P＜0.05). ROC curve analysis showed that the cut-off values of IgG and IgE in the diagnosis of SSNS were 2.57 g/L (AUC=0.717, 95%CI 0.623-0.812, P＜0.001) and 174.3 IU/ml (AUC=0.828, 95%CI 0.751-0.905, P＜0.001). The area under the ROC curve for IgG＜2.57 g/L in combination with IgE＞174.3 IU/ml in the diagnosis of SSNS was 0.904 (95%CI 0.834-0.953, P＜0.001). Logistic regression showed that children who met both IgG＜2.57 g/L and IgE＞174.3 IU/ml were 51.00 times more likely to have SSNS than those who did not (P＜0.001). Conclusion IgG combined with IgE can be used as a simple and practical clinical marker for predicting SSNS.     

Predicting post‐endoscopic retrograde cholangiopancreatography pancreatitis using the 4‐h serum lipase level

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is a complex therapeutic procedure that is complicated by pancreatitis in 3–5% of cases. The aim of this study is to determine whether a 4‐h post‐ERCP serum lipase level is superior to the serum amylase level in predicting the occurrence of post‐ERCP pancreatitis (PEP).

Methods

We performed a retrospective review of prospectively collected data on 543 consecutive patients undergoing therapeutic ERCP at a single centre. Serum lipase and amylase levels were measured at 4‐h post‐procedure and were recorded as a factor of the upper limit of normal: amylase factor (AF) and lipase factor (LF). Sensitivity and specificity were compared using receiver‐operating characteristics and the Youden index (YI).

Results

A total of 506 procedures were considered for analysis. PEP occurred in 19 patients (3.8%). A LF of <10 was useful for the exclusion of PEP with a sensitivity of 100% and a specificity of 94%, YI = 0.94. In contrast, an AF <3 yielded a sensitivity of 79% and specificity of 94%, YI = 0.73.

Conclusion

Serum lipase measured at 4‐h post‐ERCP better excludes PEP than serum amylase measured at the same time point. Patients with a LF <10 may be safely considered for same‐day discharge.     

Peritoneal lavage enzyme determinations following blunt and penetrating abdominal trauma.

Diagnostic peritoneal lavage (DPL) provides a rapid and sensitive means of investigating the peritoneal cavity following blunt and penetrating trauma. However, its shortcomings include insensitivity in the early identification of isolated hollow viscus injuries. We have routinely assayed lavage amylase (LAM) and alkaline phosphatase (LAP) in acutely injured patients for more than 4 years to assess the contribution of lavage enzyme analysis to the overall accuracy of DPL. From 1,969 DPLs, LAM was analyzed in 1,881 (96%) and LAP in 1,734 (88%) of 1,536 blunt and 433 penetrating trauma cases. Of 28 patients with negative lavage by LRBC but LAM greater than or equal to 20 IU/L, 13 (46%) had clinically significant injury requiring laparotomy. Seventy-seven percent of these cases involved the small bowel. In this group, LAM greater than or equal to 20 IU/L had a sensitivity of 87%, specificity of 75%, and positive predictive value of 46% for significant intra-abdominal injury. Seven patients had LAM greater than or equal to 20 IU/L and LAP greater than or equal to 3 IU/L. These values had a sensitivity of 54%, specificity of 98%, and positive predictive value of 88% for significant abdominal injury. Elevations of LAM (greater than or equal to 20 IU/L) and LAP (greater than or equal to 3 IU/L) mandate laparotomy where the history is consistent with possible small bowel injury. Elevation of either enzyme alone should raise the suspicion of hollow visceral organ injury and warrant close observation.