4시간 후 혈청 아밀라아제와 리파아제 농도를 이용한 내시경 역행성 췌담도 조영술 이후 췌장염 발생의 예측
Prediction of Post-ERCP Pancreatitis
- 주제(키워드) 급성췌장염 , 내시경 역행성 췌담도 조영술 , 고아밀라아제혈증
- 발행기관 아주대학교
- 지도교수 김진홍
- 발행년도 2015
- 학위수여년월 2015. 8
- 학위명 석사
- 학과 및 전공 일반대학원 의학과
- 실제URI http://www.dcollection.net/handler/ajou/000000020149
- 본문언어 영어
- 저작권 아주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
Background & Aims : Acute pancreatitis is the most common, serious complication of endoscopic retrograde cholangiopancreatography (ERCP). Early prediction of post-ERCP pancreatitis (PEP) could enable earlier safe discharge of patients on the same day after ERCP. This study investigated a predictive cut-off value of 4-hour post-ERCP serum amylase and lipase levels for PEP. Methods : We retrospectively evaluated patients who underwent ERCP procedures and testing for serum amylase and lipase 4-hours after ERCP and the next morning at Ajou Medical Center from January 2012 to August 2013. We studied; patient demographics, procedure reasons, pancreatogram performance, and serum amylase and lipase levels. Results : PEP occurred in 16 (3.1%) patients after 516 ERCP procedures. Its severity was mild in 4 (25%), moderate in 9 (56.3%), and severe in 3 (18.8%). Mean 4-hour amylase level was significantly higher in patients with PEP; than in those without (965 U/L vs. 158 U/L, P = .001). No statistically significant differences occurred in age, sex, and procedure reasons between both groups. Sensitivity, specificity and negative predictive value (NPV) of 4-hour post-ERCP amylase level with a cut-off value of 2.5x upper limit of reference (ULR) (290 U/L) were 39.1%, 98.5% and 97.2%, respectively; with a cut-off value of 8× ULR (480 U/L), they were 60.0%, 97.5% and 99.6%. The patient group undergoing pancreatogram had a high incidence of PEP; but no significant difference in 4-hour post-ERCP serum amylase and lipase, compared with its counterpart. Conclusions : Four-hour post-ERCP serum amylase and lipase levels with cut-off values of 2.5x and 8x ULR are proven useful predictive values for earlier safe discharge of patients on the same day after ERCP.
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