EARLY RECOGNITION OF POST-ERCP PANCREATITIS BY CLINICAL-ASSESSMENT AND SERUM PANCREATIC-ENZYMES

Background: This study evaluates the relative value of clinical assess ment and serum pancreatic enzymes in the discharge management of outpa tients undergoing ERCP, Methods: Two hundred thirty-one patients who u nderwent ERCP had a detailed clinical assessment performed 2 h after t he procedure and blood drawn for amylase and lipase, Results: One-thir d of the patients who later developed pancreatitis had no pain 2 h aft er the end of the procedure, whereas an equal number who had no pancre atitis did complain of pain, Values below 276 U/L for amylase and 1000 U/L for lipase were useful in ruling out pancreatitis with negative p redictive values of 0.97 and 0.98, respectively, Based on the data of this study a discharge algorithm for outpatients undergoing ERCP is pr oposed, Conclusions: In contrast to clinical assessment, which is unre liable, it is possible to stratify patients according to their risk of developing pancreatitis according to their 2-h serum amylase and lipa se values, This helps to rationalize the discharge management of outpa tients undergoing ERCP at a time when careful utilization of resources , especially the avoidance of unnecessary hospital admissions, becomes increasingly more important.