Amylase creatinine clearance ratio following biliary tract surgery.

Abstract

AbstractAn increase in the amylase creatinine clearance ratio (ACCR) is considered to be a more specific diagnostic test of acute pancreatitis than elevation of the serum or urine amylase activity. Simultaneous serum and urine samples for the determination of amylase and creatinine were obtained preoperatively and at various intervals postoperatively in 75 patients undergoing surgery. No increase in ACCR was observed in a control group of 5 patients who underwent extra‐abdominal surgery. ACCR increased significantly following cholecystectomy (40 patients) and sphincterotomy (10 patients), but did not increase in patients in whom cholecystectomy was performed without operative cholangiography and in those who underwent cholecystectomy and prophylactic treatment with Trasylol. Use of a different technique in performing sphincterotomy, probing the papilla and the duct of Wirsung transduodenally, did not lead to a significant difference in the postoperative ACCR increase. The increase in postoperative ACCR was significantly higher in patients who underwent cholecystectomy with sphincterotomy than in those who underwent cholecystectomy alone. Serum amylase levels exceeded the normal range only in a few patients. These results suggest that sphincterotomy and operative cholangiography performed without control of infusion pressure cause an increase in ACCR with values similar to those found in acute pancreatitis. However, damage to the pancreas must be mild since none of the patients developed clinical features of acute pancreatitis.