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Increased serum trypsinogen 2 and trypsin 2-α1antitrypsin complex values identify endoscopic retrogradecholangiopancreatography induced pancreatitis with high accuracy |
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| Authors: | E Kemppainen J Hedstrom P Puolakkainen J Halttunen V Sainio R Haapiainen E Kivilaakso U Stenman |
| Affiliation: | Second Department of Surgery, Helsinki University Central Hospital, Finland. |
| Abstract: | Aims—To evaluate the clinical utility of two newtests for serum trypsinogen 2 and trypsin 2-α1antitrypsin complex (trypsin 2-AAT) in diagnosing and assessing theseverity of acute pancreatitis (AP) induced by endoscopic retrogradecholangiopancreatography (ERCP). Patients—Three hundred and eight consecutivepatients undergoing ERCP at Helsinki University Central Hospital in1994 and 1995. Methods—Patients were followed prospectively forpancreatitis and clinical outcome. They were tested for serumtrypsinogen 2, trypsin 2-AAT, and amylase in samples obtained beforeand one, six, and 24 hours after ERCP. Results—Pancreatitis developed in 31 patients(10%). Their median serum trypsinogen 2 increased 26-fold to1401 µg/l at six hours after the procedure and trypsin 2-AAT showedan 11-fold increase to 88 µg/l at 24 hours. The increase in bothmarkers was stronger in severe than in mild pancreatitis, and inpatients without pancreatitis there was no significant increase.Baseline trypsinogen 2 and trypsin 2-AAT concentrations were elevatedin 29% and 32% of patients, respectively. The diagnostic accuracy ofa threefold elevation over the baseline value was therefore analysed.The sensitivity and specificity of these parameters in the diagnosis ofpost-ERCP pancreatitis was 93% and 91%, respectively, for serumtrypsinogen 2 at six hours after the examination, and 93% and 90%,for trypsin 2-AAT at 24 hours. Conclusions—Serum trypsinogen 2 and trypsin 2-AATreflect pancreatic injury after ERCP. High concentrations areassociated with severe pancreatic damage. The delayed increase intrypsin 2-AAT compared with trypsinogen 2 appears to reflect thepathophysiology of AP. A greater than threefold increase in trypsinogen2 six hours after ERCP is an accurate indicator of pancreatitis. Keywords:trypsinogen 2; trypsin 2-α1antitrypsin complex; ERCP; pancreatitis |
| Keywords: | trypsinogen 2 trypsin 2-α1antitrypsin complex ERCP pancreatitis |