Serum trypsin as an early predictor of post-endoscopic retrograde cholangiopancreatography pancreatitis.
ERCP
amylase
lipase
post‐ERCP pancreatitis
trypsin
Journal
Journal of hepato-biliary-pancreatic sciences
ISSN: 1868-6982
Titre abrégé: J Hepatobiliary Pancreat Sci
Pays: Japan
ID NLM: 101528587
Informations de publication
Date de publication:
26 Aug 2024
26 Aug 2024
Historique:
medline:
26
8
2024
pubmed:
26
8
2024
entrez:
26
8
2024
Statut:
aheadofprint
Résumé
Serum amylase (AMY) levels measured 2-6 h after ERCP are a predictor of post-ERCP pancreatitis (PEP). Trypsin is one of the pancreatic enzymes elevated in the development of PEP. The study assessed whether serum trypsin (TRY) can predict early-stage PEP. This prospective study included patients who underwent ERCP from June 2022 to May 2023. TRY, AMY, serum pancreatic AMY (P-AMY), and serum lipase (LIP) levels were measured immediately after ERCP and 2 h later. The primary outcome was the diagnostic abilities of TRY levels measured immediately (0 h-TRY) and 2 h after (2 h-TRY) ERCP to predict PEP (compared with the other serum pancreatic enzymes). Of 130 patients analyzed, 18 developed PEP. The sensitivity and specificity of 0 h-TRY were 83.3% and 69.6%, respectively, and those of 2 h-TRY were 88.9% and 72.3%, respectively. The area under the curve (AUC) for 0 h-TRY was significantly higher than that for 0 h-AMY (p = .006) and 0 h-P-AMY (p = .012), whereas the AUCs for 0 h-TRY and 0 h-LIP did not differ significantly (p = .563). The AUC for 2 h-TRY for predicting PEP was significantly higher than that for 2 h-AMY (p = .025), whereas there was no significant differences between the AUCs for 2 h-TRY and 2 h-P-AMY(p = .146), or between those for 2 h-TRY and 2 h-LIP (p = .792). The median increase ratio (expressed as a ratio relative to baseline) in TRY was highest among all of serum pancreatic enzymes tested immediately after ERCP (5.35, 1.72, 1.94, and 4.44 for TRY, AMY, P-AMY, and LIP, respectively). Measuring TRY immediately after ERCP is useful for the early prediction of PEP.
Sections du résumé
BACKGROUND
BACKGROUND
Serum amylase (AMY) levels measured 2-6 h after ERCP are a predictor of post-ERCP pancreatitis (PEP). Trypsin is one of the pancreatic enzymes elevated in the development of PEP. The study assessed whether serum trypsin (TRY) can predict early-stage PEP.
METHODS
METHODS
This prospective study included patients who underwent ERCP from June 2022 to May 2023. TRY, AMY, serum pancreatic AMY (P-AMY), and serum lipase (LIP) levels were measured immediately after ERCP and 2 h later. The primary outcome was the diagnostic abilities of TRY levels measured immediately (0 h-TRY) and 2 h after (2 h-TRY) ERCP to predict PEP (compared with the other serum pancreatic enzymes).
RESULTS
RESULTS
Of 130 patients analyzed, 18 developed PEP. The sensitivity and specificity of 0 h-TRY were 83.3% and 69.6%, respectively, and those of 2 h-TRY were 88.9% and 72.3%, respectively. The area under the curve (AUC) for 0 h-TRY was significantly higher than that for 0 h-AMY (p = .006) and 0 h-P-AMY (p = .012), whereas the AUCs for 0 h-TRY and 0 h-LIP did not differ significantly (p = .563). The AUC for 2 h-TRY for predicting PEP was significantly higher than that for 2 h-AMY (p = .025), whereas there was no significant differences between the AUCs for 2 h-TRY and 2 h-P-AMY(p = .146), or between those for 2 h-TRY and 2 h-LIP (p = .792). The median increase ratio (expressed as a ratio relative to baseline) in TRY was highest among all of serum pancreatic enzymes tested immediately after ERCP (5.35, 1.72, 1.94, and 4.44 for TRY, AMY, P-AMY, and LIP, respectively).
CONCLUSION
CONCLUSIONS
Measuring TRY immediately after ERCP is useful for the early prediction of PEP.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 Japanese Society of Hepato‐Biliary‐Pancreatic Surgery.
Références
Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335(13):909–918.
Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, et al. Risk factors for post‐ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001;54(4):425–434.
Cheng CL, Sherman S, Watkins JL, Barnett J, Freeman M, Geenen J, et al. Risk factors for post‐ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol. 2006;101(1):139–147.
Testoni PA, Mariani A, Giussani A, Vailati C, Masci E, Macarri G, et al. Risk factors for post‐ERCP pancreatitis in high‐ and low‐volume centers and among expert and non‐expert operators: a prospective multicenter study. Am J Gastroenterol. 2010;105(8):1753–1761.
Fujita K, Yazumi S, Matsumoto H, Asada M, Nebiki H, Matsumoto K, et al. Multicenter prospective cohort study of adverse events associated with biliary endoscopic retrograde cholangiopancreatography: incidence of adverse events and preventive measures for post‐endoscopic retrograde cholangiopancreatography pancreatitis. Dig Endosc. 2022;34(6):1198–1204.
Thomson A. Intravenous fluid therapy in acute pancreatitis: a critical review of the randomized trials. ANZ J Surg. 2018;88(7–8):690–696.
Stigliano S, Sternby H, de Madaria E, Capurso G, Petrov MS. Early management of acute pancreatitis: a review of the best evidence. Dig Liver Dis. 2017;49(6):585–594.
Goyal H, Sachdeva S, Sherazi SAA, Gupta S, Perisetti A, Ali A, et al. Early prediction of post‐ERCP pancreatitis by post‐procedure amylase and lipase levels: a systematic review and meta‐analysis. Endosc Int Open. 2022;10(7):E952–E970.
Bykov KM. Regulation of the work of the digestive glands. Tr Inst Fiziol Im I P Pavlova. 1960;9:14–23.
Dawra R, Sah RP, Dudeja V, Rishi L, Talukdar R, Garg P, et al. Intra‐acinar trypsinogen activation mediates early stages of pancreatic injury but not inflammation in mice with acute pancreatitis. Gastroenterology. 2011;141(6):2210–2217.
Ji B, Logsdon CD. Digesting new information about the role of trypsin in pancreatitis. Gastroenterology. 2011;141(6):1972–1975.
Hedström J, Kemppainen E, Andersén J, Jokela H, Puolakkainen P, Stenman UH. A comparison of serum trypsinogen‐2 and trypsin‐2‐alpha1‐antitrypsin complex with lipase and amylase in the diagnosis and assessment of severity in the early phase of acute pancreatitis. Am J Gastroenterol. 2001;96(2):424–430.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–111.
Dumonceau JM, Kapral C, Aabakken L, Papanikolaou IS, Tringali A, Vanbiervliet G, et al. ERCP‐related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2020;52(2):127–149.
Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37(3):383–393.
Sofuni A, Maguchi H, Mukai T, Kawakami H, Irisawa A, Kubota K, et al. Endoscopic pancreatic duct stents reduce the incidence of post‐endoscopic retrograde cholangiopancreatography pancreatitis in high‐risk patients. Clin Gastroenterol Hepatol. 2011;9(10):851.
Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71(3):446–454.
Gu J, Li Y, Yu J, Hu M, Ji Y, Li L, et al. A risk scoring system to predict the individual incidence of early‐onset colorectal cancer. BMC Cancer. 2022;22(1):122.
Tadehara M, Okuwaki K, Imaizumi H, Kida M, Iwai T, Yamauchi H, et al. Usefulness of serum lipase for early diagnosis of post‐endoscopic retrograde cholangiopancreatography pancreatitis. World J Gastrointest Endosc. 2019;11(9):477–485.
Inatomi O, Bamba S, Nakai Y, Kusumoto K, Kawakami T, Suzuki T, et al. Diagnostic value of serum amylase levels indicating computed tomography‐defined post‐endoscopic retrograde cholangiopancreatography pancreatitis: a prospective multicenter observational study. Pancreas. 2020;49(7):955–959.
Akashi R, Kiyozumi T, Tanaka T, Sakurai K, Oda Y, Sagara K. Mechanism of pancreatitis caused by ERCP. Gastrointest Endosc. 2002;55(1):50–54.
Kawabata A, Matsunami M, Sekiguchi F. Gastrointestinal roles for proteinase‐activated receptors in health and disease. Br J Pharmacol. 2008;153(Suppl 1):S230–S240.
Sendler M, Lerch MM. The complex role of trypsin in pancreatitis. Gastroenterology. 2020;158(4):822–826.
Nguyen TD, Moody MW, Steinhoff M, Okolo C, Koh DS, Bunnett NW. Trypsin activates pancreatic duct epithelial cell ion channels through proteinase‐activated receptor‐2. J Clin Invest. 1999;103(2):261–269.
Gukovskaya AS, Gukovsky I, Algül H, Habtezion A. Autophagy, inflammation, and immune dysfunction in the pathogenesis of pancreatitis. Gastroenterology. 2017;153(5):1212–1226.
Gardner TB, Vege SS, Chari ST, Petersen BT, Topazian MD, Clain JE, et al. Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in‐hospital mortality. Pancreatology. 2009;9(6):770–776.
Warndorf MG, Kurtzman JT, Bartel MJ, Cox M, Mackenzie T, Robinson S, et al. Early fluid resuscitation reduces morbidity among patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2011;9(8):705–709.
DiMagno MJ, Wamsteker EJ, Maratt J, Rivera MA, Spaete JP, Ballard DD, et al. Do larger periprocedural fluid volumes reduce the severity of post‐endoscopic retrograde cholangiopancreatography pancreatitis? Pancreas. 2014;43(4):642–647.
Sagi SV, Schmidt S, Fogel E, Lehman GA, McHenry L, Sherman S, et al. Association of greater intravenous volume infusion with shorter hospitalization for patients with post‐ERCP pancreatitis. J Gastroenterol Hepatol. 2014;29(6):1316–1320.