Use of the urinary trypsinogen-2 dipstick test in early diagnosis of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP)

Background: Acute pancreatitis is one of the most serious complications of ERCP. Early diagnosis of post ERCP pancreatitis helps physicians to provide intensive care and possible medical treatment as early as possible. Trypsinogen-2 in urine is a good diagnostic and prognostic marker of acute pancreatitis. Objectives: To evaluate the diagnostic value of urinary trypsinogen-2 dipstick test for early diagnosis of post ERCP pancreatitis. Methods: A total of 37 patients with obstructive jaundice were tested with the urinary trypsinogen-2 dipstick test and serum levels of amylase and lipase before ERCP and 6 hours after ERCP. Results: Post ERCP pancreatitis was diagnosed in 6 (16%) of 37 patients. The sensitivity, specificity, positive predictive value and negative predictive value of urinary trypsinogen-2 dipstick test at 6 hours after ERCP were 100%, 97%, 86%, 100% respectively. At the cutoff level (130 U/L) for lipase, the positive predictive value and negative predictive value all were (100%), however, the positive predictive value and negative predictive value for amylase levels at cutoff (122 U/L) were 60%, 100% respectively. Serum lipase level was the best test for diagnosing post ERCP pancreatitis followed by the urinary trypsinogen-2 dipstick test. Conclusions: The urinary trypsinogen-2 dipstick test can be used as a rapid and easy test for early diagnosis of post ERCP pancreatitis with high sensitivity and specificity.

[1]  Fake Li,et al.  Rapid urinary trypsinogen-2 test in the early diagnosis of acute pancreatitis: a meta-analysis. , 2012, Clinical biochemistry.

[2]  K. Chayama,et al.  Assessment of Trypsinogen-2 Levels as an Early Diagnostic for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis , 2011, Pancreas.

[3]  F. Chang,et al.  Rapid Urinary Trypsinogen-2 Test Strip in the Diagnosis of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography , 2011, Pancreas.

[4]  S. Stawicki,et al.  Evolving Role of Endoscopic Retrograde Cholangiopancreatography in Management of Extrahepatic Hepatic Ductal Injuries due to Blunt Trauma: Diagnostic and Treatment Algorithms , 2007, HPB surgery : a world journal of hepatic, pancreatic and biliary surgery.

[5]  Angelo Andriulli,et al.  Incidence Rates of Post-ERCP Complications: A Systematic Survey of Prospective Studies , 2007, The American Journal of Gastroenterology.

[6]  N. Fujita,et al.  Relationship between post-ERCP pancreatitis and the change of serum amylase level after the procedure. , 2007, World journal of gastroenterology.

[7]  D. Pleskow,et al.  SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). , 2007, Gastrointestinal endoscopy.

[8]  S. Sankaralingam,et al.  Use of the urinary trypsinogen-2 dip stick test in early diagnosis of pancreatitis after endoscopic retrograde cholangiopancreatography , 2007, Surgical Endoscopy.

[9]  R. Carter,et al.  Diclofenac reduces the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography. , 2003, Gastroenterology.

[10]  F. Chang,et al.  Early Changes of Serum Proinflammatory and Anti-inflammatory Cytokines After Endoscopic Retrograde Cholangiopancreatography , 2003, Pancreas.

[11]  M. Freeman.  Adverse outcomes of ERCP. , 2002, Gastrointestinal endoscopy.

[12]  U. Stenman,et al.  Rapid measurement of urinary trypsinogen-2 as a screening test for acute pancreatitis. , 1997, The New England journal of medicine.

[13]  U. Stenman,et al.  Urinary trypsinogen-2 test strip in detecting ERCP-induced pancreatitis. , 1997, Endoscopy.

[14]  M. E. Ryan,et al.  Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. , 1997, Gastrointestinal endoscopy.

[15]  U. Stenman,et al.  Urinary trypsinogen-2 test strip for acute pancreatitis , 1996, The Lancet.

[16]  S. Sherman,et al.  ERCP‐ and Endoscopic Sphincterotomy‐Induced Pancreatitis , 1991, Pancreas.

[17]  P. Testoni,et al.  Pain at 24 hours associated with amylase levels greater than 5 times the upper normal limit as the most reliable indicator of post-ERCP pancreatitis. , 2001, Gastrointestinal endoscopy.