Relationship between post-ERCP pancreatitis and the change of serum amylase level after the procedure

Table 1 Characteristics and diagnosis of the patients

Parameters	Results
No. of patients (n)	1291
Mean age (yr, range)	64 (12-96)
Male:female	738:553
Pancreatic duct opacification	875 (68%)
Difficult bile duct cannulation	107 (8%)
Intraductal ultrasonography	266 (20)
Biliary sphincterotomy	270 (20%)
Biliary stent placement	60 (112%)
Papillary balloon dilatation	50 (3.8%)
Cytology of the bile/pancreatic juice	53 (4.1%)
Biopsy of the bile/pancreatic duct	78 (6.0%)
Gallbladder stone	488 (38%)
Choledocholithiasis	313 (24%)
Cholangiocarcinoma	75 (6%)
Pancreatic cancer	73 (6%)
Intraductal papillary mucinous neoplasm	63 (4%)
Ampullary cancer	23 (2%)
Pancreaticobiliary maljunction	20 (2%)

Table 2 Risk factors of post-ERCP pancreatitis

	Pancreatitis (+)(n = 47)	Pancreatitis (-)(n = 1244)	P
Male:female	31:16	707:537	0.21
Pancreatic duct opacification	37 (78%)	838 (67%)	0.10
Difficult bile duct cannulation	7 (14%)	100 (8%)	0.09
Intraductal ultrasonography	13 (28%)	253 (20%)	0.22
Biliary sphincterotomy	12 (26%)	258 (20%)	0.42
Biliary stent placement	10 (21%)	150 (12%)	0.06
Biliary stent placement without sphx1	5 (10%)	42 (3%)	0.026
Papillary balloon dilatation	4 (8%)	46 (4%)	0.20
Cytology of the bile/pancreatic juice	4 (8%)	49 (3.9%)	0.12
Biopsy of the bile/pancreatic duct	2 (4%)	76 (6%)	0.60
Gallbladder stone	15 (32%)	433 (34%)	0.68
Choledocholithiasis	15 (32%)	298 (24%)	0.21
Cholangiocarcinoma	5 (10%)	70 (6%)	0.14
Pancreatic cancer	3 (6%)	70 (6%)	0.92
Intraductal papillary mucinous neoplasm	5 (10%)	58 (4%)	0.12
Ampullary cancer	0	23 (2%)	0.70
Pancreaticobiliary maljunction	0	20 (2%)	0.78

¹Sphx: sphincterotomy.

Table 3 Correlation between the change in serum amylase level and post-ERCP pancreatitis

Serum amylase values	Pancreatitis rate
	3 h		6 h	24 h
> 10 times	39% (12/31)	21% b	44% (26/59)	59% (27/46)	49% d
5-10 times	31% (14/45)		18% (9/49)	38% (14/37)
3-5 times	20% (10/49)		8% (5/57)	6% (3/47)	0.5% d
2-3 times	5% (3/63)		5% (3/61)	6% (3/49)
1-2 times	1% (3/217)	0.7% b	1% (2/196)	0% (0/206)
≤normal	1% (5/886)		1% (2/869)	0% (0/906)

^bP < 0.001 vs 0.7%; ^dP < 0.001 vs 0.5%.

Table 4 Serum amylase level as a predictive factor of post-ERCP pancreatitis

Time after ERCP	Amylase level	Sensitivity (%)	PPV (%)
3 h	> Upper normal limit	89	10
	> 2 times	83	21
	> 3 times	77	29
	> 5 times	55	34
	> 10 times	26	39
6h	> Upper normal limit	96	11
	> 2 times	91	19
	> 3 times	85	24
	> 5 times	74	32
	> 10 times	55	44

PPV: positive predictive value.