Post-procedure serum amylase or lipase levels predict post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of diagnostic test accuracy studies and utility assessment.

Abstract

To clarify the clinical utility of measuring serum pancreatic enzymes after endoscopic retrograde cholangiopancreatography (ERCP) for the purpose of predicting post-ERCP pancreatitis (PEP) by a meta-analysis of diagnostic test accuracy studies. Studies on the prediction accuracy of PEP by serum amylase or lipase measured 2, 3, and 4 hours after ERCP were collected. A literature search was performed in PubMed and the Cochrane Library database for studies published between January 1980 and March 2023. The quality of individual studies was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2. Data were analyzed using Meta-DiSc 2.0 software. We searched databases and identified 20 observational studies (12,313 participants). PEPs were defined according to criteria by Cotton or modified Cotton, revised Atlanta criteria, or the Japanese criteria. Meta-analysis of 8 studies (4,389 participants) showed pooled sensitivity of 71.1% (95% confidence interval (CI): 56.1-82.5) and pooled specificity of 91.2% (95% CI: 85.9-94.6) for serum amylase cutoff value at 3 times the upper limit of normal (ULN). Another meta-analysis of 5 studies (1,970 participants) showed pooled sensitivity of 85.8% (95% CI: 61.9-95.7) and pooled specificity of 85.3% (95% CI: 81.9-88.1) for serum lipase cutoff value at 3 times ULN. Despite a high risk of bias due to various reference standards, this updated meta-analysis and the utility assessment by a decision tree showed utility of serum amylase or lipase levels more than 3 times ULN measured 2 to 4 hours after ERCP for predicting PEP.