INCREASED SERUM TRYPSINOGEN-2 AND TRYPSIN-2-ALPHA(1) ANTITRYPSIN COMPLEX VALUES IDENTIFY ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY INDUCED PANCREATITIS WITH HIGH-ACCURACY

Aims-To evaluate the clinical utility of two new tests for serum tryps inogen 2 and trypsin 2-alpha(1) antitrypsin complex (trypsin 2-AAT) in diagnosing and assessing the severity of acute pancreatitis (AP) indu ced by endoscopic retrograde cholangiopancreatography (ERCP). Patients -Three hundred and eight consecutive patients undergoing ERCP at Helsi nki University Central Hospital in 1994 and 1995. Methods-Patients wer e followed prospectively for pancreatitis and clinical outcome. They w ere tested for serum trypsinogen 2, trypsin 2-AAT, and amylase in samp les obtained before and one, six, and 24 hours after ERCP. Results-Pan creatitis developed in 31 patients (10%). Their median serum trypsinog en 2 increased 26-fold to 1401 mu g/l at six hours after the procedure and trypsin 2-AAT showed an 11-fold increase to 88 mu g/l at 24 hours . The increase in both markers was stronger in severe than in mild pan creatitis, and in patients without pancreatitis there was no significa nt increase. Baseline trypsinogen 2 and trypsin 2-AAT concentrations w ere elevated in 29% and 32% of patients, respectively. The diagnostic accuracy of a threefold elevation over the baseline value was therefor e analysed. The sensitivity and specificity of these parameters in the diagnosis of post-ERCP pancreatitis was 93% and 91%, respectively, fo r serum trypsinogen 2 at six hours after the examination, and 93% and 90%, for trypsin 2-AAT at 24 hours. Conclusions-Serum trypsinogen 2 an d trypsin 2-AAT reflect pancreatic injury after ERCP. High concentrati ons are associated with severe pancreatic damage. The delayed increase in trypsin 2-AAT compared with trypsinogen 2 appears to reflect the p athophysiology of AP. A greater than threefold increase in trypsinogen 2 six hours after ERCP is an accurate indicator of pancreatitis.