Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2019; 11(9): 477-485
Published online Sep 16, 2019. doi: 10.4253/wjge.v11.i9.477
Usefulness of serum lipase for early diagnosis of post-endoscopic retrograde cholangiopancreatography pancreatitis
Masayoshi Tadehara, Kosuke Okuwaki, Hiroshi Imaizumi, Mitsuhiro Kida, Tomohisa Iwai, Hiroshi Yamauchi, Toru Kaneko, Rikiya Hasegawa, Eiji Miyata, Yusuke Kawaguchi, Hironori Masutani, Wasaburo Koizumi
Masayoshi Tadehara, Kosuke Okuwaki, Hiroshi Imaizumi, Mitsuhiro Kida, Tomohisa Iwai, Hiroshi Yamauchi, Toru Kaneko, Rikiya Hasegawa, Eiji Miyata, Yusuke Kawaguchi, Hironori Masutani, Wasaburo Koizumi, Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa 2520375, Japan
Author contributions: All authors helped to perform the research; Tadehara M wrote manuscript and performed procedures and data analysis; Okuwaki K and Imaizumi H drafted the concepts and designed the study; Kida M, Iwai T, Yamauchi H, Kaneko T, Hasegawa R, Miyata E, Kawaguchi Y, Masutani H and Koizumi W offered technical or material support; All the authors discussed the results and commented on the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Kitasato University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to endoscopic retrograde cholangiopancreatography by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kosuke Okuwaki, MD, PhD, Doctor, Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 2520375, Japan. kokuwaki@kitasato-u.ac.jp
Telephone: +81-42-7788111 Fax: +81-42-7789371
Received: July 12, 2019
Peer-review started: July 12, 2019
First decision: August 2, 2019
Revised: August 21, 2019
Accepted: August 9, 2019
Article in press: August 9, 2019
Published online: September 16, 2019
Processing time: 63 Days and 13.4 Hours
Abstract
BACKGROUND

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is new onset acute pancreatitis after ERCP. This complication is sometimes fatal. As such, PEP should be diagnosed early so that therapeutic interventions can be carried out. Serum lipase (s-Lip) is useful for diagnosing acute pancreatitis. However, its usefulness for diagnosing PEP has not been sufficiently investigated.

AIM

This study aimed to retrospectively examine the usefulness of s-Lip for the early diagnosis of PEP.

METHODS

We retrospectively examined 4192 patients who underwent ERCP at our two hospitals over the last 5 years. The primary outcomes were a comparison of the areas under the receiver operating characteristic (ROC) curves (AUCs) of s-Lip and serum amylase (s-Amy), s-Lip and s-Amy cutoff values based on the presence or absence of PEP in the early stage after ERCP via ROC curves, and the diagnostic properties [sensitivities, specificities, positive predictive values (PPV), and negative predictive value (NPV)] of these cutoff values for PEP diagnosis.

RESULTS

Based on the eligibility and exclusion criteria, 804 cases were registered. Over the entire course, PEP occurred in 78 patients (9.7%). It occurred in the early stage after ERCP in 40 patients (51.3%) and in the late stage after ERCP in 38 patients (48.7%). The AUCs were 0.908 for s-Lip [95% confidence interval (CI): 0.880-0.940, P < 0.001] and 0.880 for s-Amy (95%CI: 0.846-0.915, P < 0.001), indicating both are useful for early diagnosis. By comparing the AUCs, s-Lip was found to be significantly more useful for the early diagnosis of PEP than s-Amy (P = 0.023). The optimal cutoff values calculated from the ROC curves were 342 U/L for s-Lip (sensitivity, 0.859; specificity, 0.867; PPV, 0.405; NPV, 0.981) and 171 U/L for s-Amy (sensitivity, 0.859; specificity, 0.763; PPV, 0.277; NPV, 0.979).

CONCLUSION

S-Lip was significantly more useful for the early diagnosis of PEP. Measuring s-Lip after ERCP could help diagnose PEP earlier; hence, therapeutic interventions can be provided earlier.

Keywords: Endoscopic retrograde cholangiopancreatography; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Pancreatitis; Lipase; Amylase

Core tip: Serum lipase (s-Lip) is useful for diagnosing acute pancreatitis. The aim of this study was to retrospectively examine the usefulness of s-Lip for the early diagnosis of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Based on the eligibility and exclusion criteria, 804 cases were registered. Over the entire course, PEP occurred in 78 patients. The areas under the receiver operating characteristic curves (AUCs) were 0.908 for s-Lip (P < 0.001) and 0.880 for serum amylase (s-Amy) (P < 0.001), indicating both are useful for early diagnosis. By comparing the AUCs, s-Lip was found to be significantly more useful for the early diagnosis of PEP than s-Amy (P = 0.023).