Urinary Trypsinogen-2 Research Articles

Noninvasive rapid urinary trypsinogen-2 dipstick test for early exclusion of post-endoscopic retrograde cholangiopancreatography pancreatitis within hours after endoscopic retrograde cholangiopancreatography: Clinical diagnosis and considerations.

Few reports have explored the application of urinary trypsinogen-2 measurement in the early diagnosis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, and none have demonstrated the benefits of noninvasive testing. This study aimed to evaluate the clinical application of the rapid urinary trypsinogen-2 dipstick test (Nipro, Japan) compared with serum amylase and lipase levels for the early diagnosis of post-ERCP pancreatitis (PEP). A total of 100 consecutive patients (54 men and 46 women) who were admitted and underwent ERCP at Tokyo Medical University Hospital from August 2021 to December 2021 were recruited. All patients underwent rapid urinary trypsinogen-2 measurement using the dipstick test before and after ERCP. Measurements were taken 24 h before ERCP for pre-ERCP and 1-4 h after ERCP for post-ERCP. Additionally, serum amylase and lipase levels were measured at 8:00 a.m. of the day after ERCP (at least 8 h after ERCP), and their diagnostic abilities for PEP were compared and evaluated. PEP occurred in 5/100 patients (5%). The sensitivity, specificity, positive predictive value, and negative predictive value of the dipstick test for diagnosing PEP were 100%, 83.2%, 23.8%, and 100%, respectively. These results were comparable to the diagnostic performance of serum amylase and lipase levels at 8:00 a.m. on the day after ERCP (at least 8 h after ERCP). However, false positives must be considered. The dipstick test may be useful in clinical practice as a noninvasive screening test for the early prediction of PEP.

Impact of renal dysfunction on the diagnosis of acute pancreatitis using urinary trypsinogen-2: A retrospective study.

Early diagnosis of acute pancreatitis is crucial, and urinary trypsinogen has been recently reported as a useful biomarker for diagnosing acute pancreatitis. We aimed to evaluate the impact of renal dysfunction on the diagnostic performance of urinary trypsinogen-2 for acute pancreatitis. We conducted a retrospective study using the clinical data of patients who visited the Department of Emergency and Critical Care at the University of Tokyo Hospital between 1 October, 2021, and 30 June, 2022. Patients with available data on qualitative urinary trypsinogen-2 levels were identified. We compared the urinary trypsinogen-2 levels among patients who were clinically diagnosed with acute pancreatitis. We further stratified the patients according to renal function parameters, such as serum creatinine level, blood urea nitrogen level, and estimated glomerular filtration rate, and evaluated the performance of urinary trypsinogen-2 as a biomarker for acute pancreatitis. Within 9 months, 35 patients were identified. Of them, 22 patients showed positive results and 13 showed negative results on the urinary trypsinogen-2 test. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.80, 0.40, 0.18, and 0.92, respectively. Based on the blood urea nitrogen level and estimated glomerular filtration rate, the prevalence of false-positive results was significantly higher in patients with reduced renal function than in those with normal renal function. In patients with reduced renal function, the urinary trypsinogen-2 qualitative test results might be interpreted with caution when used for diagnosing acute pancreatitis.

A Comparative Study of Rapid Trypsinogen 2 Strip Test Versus Serum Amylase and Serum Lipase in Diagnosis of Acute Pancreatitis in A Tertiary Care Hospital, Salem

Aims & Objectives: To assess the diagnostic usefulness of a quick urine trypsinogen 2 strip test to blood amylase and lipase in instances with acute pancreatitis. Methods: Patients who may have an acute pancreatitis diagnosis and have recent onset of stomach pain are included. In these cases, serum samples of amylase and lipase are sent before a urine sample is examined using a dipstick test for urinary trypsinogen-2. Fifty-two participants were included in the research. Ultrasound and CECT abdomen were used to monitor patients and confirm the diagnosis. A number of metrics were computed and compared, including sensitivity, specificity, PPV, NPV, and accuracy. Result: During June 2022 and June 2023, 52 consecutive patients complaining of upper abdominal discomfort were included in the research. Acute pancreatitis was the diagnosed diagnosis in 45 of the 52 patients, whereas other causes of abdominal discomfort were present in 7 individuals. The pee dipstick test was positive in 44 of the 45 instances, but was negative in 5 of the 7 cases when the discomfort in the abdomen was caused by anything other than a urinary tract infection. It was shown to have a 97.78 percent sensitivity, a 71.43 percent specificity, and a 94.23 % accuracy. Conclusion: Acute pancreatitis may be diagnosed quickly and easily with a fast urine trypsinogen-2 test. This study shows that the dipstick test is just as accurate as the gold standard procedures and may be used alternately with them.

S117 Diagnostic Accuracy of the Urine trypsinogen-2 Dipstick Test in Early Post-ERCP Pancreatitis Prediction

S117 Diagnostic Accuracy of the Urine trypsinogen-2 Dipstick Test in Early Post-ERCP Pancreatitis Prediction

The Predictive Value of Urinary Trypsinogen-2 Dipstick for Early Diagnosis of Acute Pancreatitis in Intensive Care

Abstract Background Acute pancreatitis is a sudden inflammation in the pancreas, with potential and variable involvement of adjacent organs or other organ systems. Aim of the Work to evaluate the rule of urinary trypsinogen-2 using dipstick test in the diagnosis of acute pancreatitis. Patients and Methods This cross-sectional study was carried out in surgical intensive care unit, Ain Shams University hospitals, during a period of 6 months. Forty five patients were included in our study, thirty patients were diagnosed as acute pancreatitis and fifteen patients weren’t diagnosed as acute pancreatitis through cross sectional study. All patients were subjected to full history taking, full clinical examination, laboratory investigations including serum levels of renal function tests, CBC, total and direct bilirubin, liver enzymes, alkaline phosphatase, INR, amylase and lipase. Urinary trypsinogen-2 dipstick test was done. Also, radiological examinations were done using ultrasonography of abdomen and pelvis, computed tomography of the abdomen. Results The most common cause of acute pancreatitis was gall stone obstructive pancreatitis (70%) and we found that serum amylase and lipase were elevated in (83.3% and 86.7% respectively) in acute pancreatitis patients. While the sensitivity of urinary trypsinogen-2 dipstick test was 93.3% in acute pancreatitis patients. The specificity of serum amylase, serum lipase was 73.3% for both of them, while the specificity of urinary trypsinogen-2 was 100% in diagnosis of acute pancreatitis. Conclusion In-conclusion urinary trypsinogen-2 dipstick test is a promising low cost, bed side and easy test to be done in the diagnosis of acute pancreatitis.

Role of inflammatory and nutritional markers in predicting complications after pancreaticoduodenectomy

BackgroundPancreaticoduodenectomy is associated with considerable morbidity and mortality rates. Early recognition of patients likely to develop severe postoperative complications will allow the timely commencement of a tailored approach. This study aimed to predict postoperative complications using inflammatory and nutritional markers measured early in the postoperative period. MethodsPatients who underwent pancreaticoduodenectomy between June 2019 and November 2020 were included in the study. Postoperative pancreatic fistula, delayed gastric emptying, and postoperative pancreatic hemorrhage were graded according to the International Study Group of Pancreatic Fistula and the International Study Group of Pancreatic Surgery. We also documented other complications such as wound infection, intra-abdominal collection, and nonsurgical complications. Nutritional and inflammatory markers were analyzed on postoperative days 1 and 3. Patients were followed up for 30 days or until discharge, depending on which was longer. ResultsOf the 58 enrolled patients, 51 were included in the study. The incidence of postoperative pancreatic fistula was 51% (clinically relevant postoperative pancreatic fistula 27.4%), delayed gastric emptying was 80.4% (clinically relevant delayed gastric emptying 43%), postoperative pancreatic hemorrhage was 3.9%, intra-abdominal collection was 23.5%, and wound infection was 29.4%. The median drain fluid interlukin-6 levels on postoperative day 1 and postoperative day 3 were significantly higher in patients developing clinically relevant postoperative pancreatic fistula than in those who did not develop clinically relevant postoperative pancreatic fistula on postoperative day 1 (211 [125, 425] fg/dL vs 99 [15, 170] fg/dL, [P = .045]) and on postoperative day 3 (110 [22, 28] fg/dL vs 10 [1.8, 45] fg/dL [P = .002]). Patients who tested negative for urine trypsinogen-2 on postoperative day 3 had a significantly lower probability of developing clinically relevant postoperative pancreatic fistula than those who tested positive (1 vs 24 [P < .001]). A model comprising both drain fluid interlukin-6 and urine trypsinogen-2 on postoperative day 3 definitively ruled out the occurrence of clinically relevant postoperative pancreatic fistula. ConclusionDrain fluid interlukin-6 and urine trypsinogen-2 on postoperative day 3 ruled out the occurrence of clinically relevant postoperative pancreatic fistula.

Evaluating the efficacy of urinary trypsinogen-2 Dipstick test in diagnosing acute pancreatitis

Acute Pancreatitis (AP) is a very common cause of acute abdomen in emergency department. The disease may vary from mild self-limiting symptoms to multi organ failure and has high mortality rate. Although most of the cases are treated by mild symptomatic treatment but severe cases require intensive monitoring, so early diagnosis and goal directed treatment is very essential to reduce mortality and morbidity of disease. The present study aims to know the efficacy of urinary trypsinogen-2 dipstick test in early diagnosis of acute pancreatitis. The prospective study sample included 98 patients who were presented to emergency department of Maharaja Krishna Chandra Gajapati Medical College &amp; Hospital (MKCGMCH), Berhampur between August 2018 and July 2020 with acute severe pain abdomen suggestive of acute pancreatitis. Urine sample were obtained and results were recorded. Blood sample of all the patients were sent for serum amylase, lipase. Urinary Trypsinogen (UT)-2 dipstick test, based on principle of immunochromatographic, was done at the time of admission and serum amylase and lipase were sent for all patients. Serum Lipase was done through Calorimetric Method and Serum Amylase was done through Coupled Enzymatic Assay Method. Ultrasonography (USG) and Contrast-Enhanced Computed tomography (CECT) abdomen were sent after 4-5 days of admission and final diagnosis was made on the basis of CECT report. Of 98 patients, 47 cases were final diagnosed to have acute pancreatitis. Sensitivity and specificity of Urinary Trypsinogen (UT)-2 was found to be 91.48% and 94.11% respectively and Positive Predictive Value (PPV) and Negative Predictive Value (NPV) was found to be 93.47% and 92.30% respectively. Sensitivity, specificity, PPV and NPV of Serum Amylase was found to be 76.5%, 74.5%, 74.5% and 74.5% respectively and similarly, sensitivity, specificity, PPV and NPV was found to be 80.85%, 72.5%, 73.1% and 80.4% respectively. Urinary Trypsinogen (UT)-2 Dipstick test has high sensitivity, specificity, PPV and NPV and therefore can be used reliably in emergency setting for diagnosis and thereby start a goal directed treatment and thus, reduce the mortality and morbidity of the disease.

Urine Trypsinogen-2 as a Noninvasive Screening Test for Predicting Post-ERCP Pancreatitis (PEP)

Background and Objectives: post endoscopic retrograde cholangiopancreatography pancreatitis (post-ERCP) pancreatitis (PEP) is a notorious complication of ERCP procedure with varying incidence and severity across literature. There is a dearth of screening modalities which can accurately predict PEP in the immediate postprocedure period. The objective of our study was to assess the reliability of a rapid urine trypsinogen-2 dipstick test in predicting PEP at 4 h post-ERCP. Methods: This was a prospective, single center, analytical study conducted over a period of eighteen months among 124 patients who underwent ERCP for various biliary indications at SRM Institute for Medical Sciences Hospital, Chennai. Patients with acute or chronic pancreatitis and those undergoing any form of pancreatic endotherapy were specifically excluded. Urine samples were collected at 4 h postprocedure and tested for trypsinogen-2 using a commercially available, rapid urine dipstick test with a lower limit of detection of 50 mg/L. Patients were subsequently followed up for a day and assessed clinically and biochemically for the development of PEP. Results: After excluding 57 patients out of the 124 as per the exclusion criteria, a total of 79 patients who underwent ERCP for various biliary indications were ultimately enrolled for the study and subsequent analysis. Three out of the seventy nine patients in the study population were diagnosed to have PEP (3.79%) and one out of the three patients developed severe acute PEP. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of urine trypsinogen-2 at 4 h post-ERCP as a predictor of PEP were 66.7%, 92.1%, 25%, 98.3% and 91.1%, respectively. Serum lipase levels were elevated more than or equal to three times upper limit of normal in a total of eleven patients (11/79). 8/11 patients had asymptomatic hyperlipasemia. Median serum lipase level in patients with PEP was 864 U/L. Conclusion: Urine trypsinogen 2 dipstick can be reliably used as a screening test in ruling out PEP and guiding clinicians in discharging patients on the day of ERCP procedure. However, larger, blinded studies with lesser logistic limitations are needed to provide further evidence to extrapolate our data and advocate the utilization of this test in routine practice.

Sensitivity and Specificity of Urine Trypsinogen 2 Dip Test in Acute Upper Abdominal Pain for the Diagnosis of Acute Pancreatitis

Sensitivity and Specificity of Urine Trypsinogen 2 Dip Test in Acute Upper Abdominal Pain for the Diagnosis of Acute Pancreatitis

A comparative analysis of urine trypsinogen-2 test strip with serum lipase and serum amylase in diagnosis of acute pancreatitis

Background: Acute pancreatitis possess difficulty in diagnosis in its emergency presentation. Hence segregation of this disease from other specific or non-specific causes of acute abdomen is important. In majority of the suspected cases, the urinary trypsinogen-2 test strip can be used to detect this disease, especially in emergency set-up. The aim and objective of the study was to evaluate the sensitivity and specificity of urinary trypsinogen-2 and to compare it with that of the standard biochemical markers of acute pancreatitis serum amylase and serum lipase.Methods: All patients who presented to the surgical emergency with symptoms and signs suspicious of acute pancreatitis were included in the study, rapid urinary trypsinogen-2 test was done immediately at the bed side, serum amylase and lipase was send for all cases along with routine investigations.Results: The urinary trypsinogen-2 test was sensitive in 96.1% cases and specific in 82.6% cases. The sensitivity is superior to that of serum lipase (sensitivity-90.2%) and serum amylase (sensitivity-84.3%). The high sensitivity of the urinary trypsinogen-2 test resulted in very high negative predictive value of 90.5%, hence a negative test almost rules out the diagnosis of acute pancreatitis.Conclusions: In patients with acute abdominal pain with suspicion of acute pancreatitis seen in emergency department, a negative dipstick for urinary trypsinogen-2 rules out acute pancreatitis with high degree of probability and therefore appears to be more suitable for screening of acute pancreatitis.

Utility of point-of-care urine trypsinogen dipstick test for diagnosing acute pancreatitis in an emergency unit.

Background: A point-of-care diagnostic test for acute pancreatitis could help in early triage and management of this condition. Materials & methods: Urine trypsinogen dipstick test (UTDT) was performed in consecutive cases suspected to have acute pancreatitis and diagnostic accuracy calculated. Results: Of 187 patients, 90 were have acute pancreatitis and UTDT was positive in 61 (67.7%). In the 97 nonpancreatitis cases, UTDT was positive in nine (9.3%). The sensitivity and specificity of UTDT for acute pancreatitis was 67.8% and 90.7%, respectively. In patients presenting within 3days of abdominal pain, sensitivity and specificity were 72.7% and 91.8%, respectively. Discussion: While offering the possibility of a point of care diagnosis, the low sensitivity of UTDT could be a concern with its routine use.

Diagnostic role of rapid urinary trypsinogen-2 strip test in acute pancreatitis

Acute pancreatitis is one of the most common surgical conditions that present with acute abdomen. Serum amylase and lipase are one of the most important and widely used laboratory methods to diagnosis acute pancreatitis. However, these tests have had unsatisfactory results in terms of their sensitivity and specificity. Urinary trypsinogen-2 strip test has been developed for the detection of increased levels of trypsinogen-2 in urine and has been suggested to play an important role in the screening of aucte pancreatitis on the basis of its rapid results. In this review, we aimed to assess the diagnostic role of the same existing articles using databases like pubmed, google scholar, medline, pubmed central. We analysed about 50 articles all of which were in English and 15 were excluded on the basis of our subject criteria.

RAPID URINE TRYPSINOGEN-2 DIPSTICK ASSAY TO DIAGNOSE ACUTE PANCREATITIS IN EMERGENCY SETUP

Background: Early diagnosis of acute pancreatitis remains a challenge in emergency set up. The early management results in better outcomes but none of the available investigations were rapid and accurate to guide the management in these patients. Hence in suspected cases of acute pancreatitis, the urinary trypsinogen 2 dipstick assay can be used to diagnose them at the earliest in the Emergency setup. The purpose of this study is to determine the accuracy of urine trypsinogen 2 assay in diagnosing acute pancreatitis. Methods: The patients presenting with symptoms consistent with acute pancreatitis to the emergency department, at a tertiary care hospital in Southern India between November 2018 to November 2019 were included in a prospective observational study after obtaining Institutional ethical committee clearance. In addition to the routine investigations done in cases of acute abdomen, patients underwent urine trypsinogen 2 dipstick test. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were calculated. Results were compared. Results: A total of 50 cases were included in the study. The urine trypsinogen 2 dipstick test was positive in 35 of 37 patients with acute pancreatitis (sensitivity, 94.59%) and in none of 13 patients with abdominal pain but without any evidence of acute pancreatitis (specificity, 100%). The diagnostic accuracy of the urine trypsinogen 2 dipstick test was 96% in this study higher than other conventional laboratory investigations. Conclusion: This study shows that the dipstick test has high diagnostic accuracy and can be considered for regular use for diagnosing pancreatitis along with the conventional methods.

Repeated Negative Urine Trypsinogen-2 Dipstick Test Rules Out Diagnosis of Post-ERCP Pancreatitis

A dipstick test for urine trypsinogen-2 has been used in the diagnosis of acute pancreatitis, but there are only a few studies exploring the effectiveness of this test for early diagnose of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). The authors explore if the rapid point-of-care urine trypsinogen-2 dipstick test can replace assay of amylase in diagnosing PEP. For this prospective study, from Helsinki University Hospital 400 ERCP patients were enrolled in whom the authors analyzed plasma amylase or pancreas-specific amylase, bilirubin, and urine trypsinogen-2, and urine trypsinogen-2 with dipstick before, 4 and 24 hours after ERCP. PEP developed in 15 (3.8%) patients. Urine trypsinogen-2 concentrations were significantly higher in PEP than in non-PEP patients 24 hours after ERCP (P=0.001, Mann-Whitney U test) but not 4 hours after ERCP (P=0.094). When combined with abdominal pain symptoms at 4 hours the dipstick test had a sensitivity of 60%, a specificity of 99%, a positive predictive value of 64%, and a negative predictive value 98%. At 24 hours, sensitivity was 100%, specificity 98%, positive predictive value 71%, and negative predictive value 100%. A positive dipstick seems to identify PEP cases and a negative test excludes PEP with high accuracy.

What is the accuracy of urinary trypsinogen and amylase for the diagnosis of acute pancreatitis?

What is the accuracy of urinary trypsinogen and amylase for the diagnosis of acute pancreatitis?

Urinary trypsinogen-2 level and local complications of acute pancreatitis.

Local complications of acute pancreatitis (AP) carry risks of morbidity/mortality. This study aimed to assess whether urinary trypsinogen-2 levels and Bedside Index for Severity in Acute Pancreatitis (BISAP) score on admission predicted subsequent local complications. One hundred and forty-four consecutive patients with AP were prospectively followed till 6months after discharge. Urinary trypsinogen-2 levels were measured within 24h of admission. Local complications (acute peripancreatic fluid collection, acute necrotic collection, pseudocyst, and walled-off necrosis) were diagnosed by abdominal computed tomography. Cut-off for trypsinogen-2 level was assessed using receiver operating characteristic curve, and predictors of local complications were analyzed by logistic regression. Thirty-seven (25.7%) patients developed local complications. Urinary trypsinogen-2 levels were significantly higher in patients with local complications compared with those without local complications (median [interquartile range], 3210 [620-9764.4] μg/L vs 627.3 [72.3-5895] μg/L, P=0.006). Urinary trypsinogen-2 significantly outperformed BISAP score in predicting local complications (area under the receiver operating characteristic curve 0.65 [95% CI: 0.55-0.75] vs 0.48 [95% CI: 0.38-0.58], P=0.005). At the optimal cut-off of 500μg/L, the sensitivity, specificity, positive predictive value, and negative predictive value of trypsinogen-2 level were 78.4%, 45.8%, 33.3%, and 86.0%, respectively. Urinary trypsinogen-2 level>500μg/L was an independent predictor of local complications (adjusted odds ratio, 3.72; 95% CI: 1.42-9.76; P=0.007). By contrast, BISAP score≥3 and pleural effusion predicted organ failure but not local complications. In a prospective cohort, urinary trypsinogen-2 level>500μg/L independently predicted local complications of AP.

A comparative analysis of urine trypsinogen-2 test strip with serum lipase in diagnosis of acute pancreatitis in emergency set-up

Background: Acute pancreatitis possess difficulty in diagnosis in its emergency presentation. Hence to segregate this disease is important from other specific or non-specific causes of acute abdomen. Hence in suspected cases in majority of patients the urinary trypsinogen-2 test strip (Actim pancreatitis) can be used to detect this disease, especially in emergency set-up. The result of the strip test is then corroborated with findings of serum lipase in the blood.Methods: Author prospectively compared 205 consecutive patients with acute abdominal pain admitted to the casualty, SCB Medical College and Hospital. The patients were tested on admission with the Actim pancreatitis test strip. Serum amylase, serum lipase, and urine trypsinogen-2 concentrations were also determined quantitatively.Results: The Actim pancreatitis test strip was sensitive in 93% cases and specific in 92% cases. This was superior to that of serum lipase (sensitivity 77% and specificity 87%). With a cut-off &gt;3x the upper reference limit, the sensitivity of serum lipase was only 52% while the specificity was 98%. The high sensitivity for the Actim pancreatitis test strip resulted in every high negative predictive value of 99%.Conclusions: In patients with acute abdominal pain seen in emergency department, a negative dipstick for urinary trypsinogen-2 rules out acute pancreatitis with high degree of probability and therefore appears to be more suitable for screening of acute pancreatitis. With its high specificity with a cut-off &gt;3x the upper reference limit, serum lipase is suitable as a confirmatory test for pancreatitis when a positive dipstick result is obtained.

Predictive Value of Urinary Trypsinogen-2 Dipstick for Early Diagnosis of Acute Pancreatitis in Emergency Medicine

AbstractBackground: Acute pancreatitis is a grave condition that requires fast and accurate diagnosis to save lives and prevent complications. In this study, we evaluated the fast and bedside urinary trypsinogen-2dipstick test in the diagnosis of acute pancreatitis.Aim of Work: This study was designed to evaluate the predictive value of the rapid urinary trypsinogen-2 test strip in acute pancreatitis, in comparison with serum amylase and serum lipase in Emergency Department at Tanta University Hospital.Subjects and Methods: Thirty-five (35) patients with acute pancreatitis (Group I) and thirty-four (34) patients with other causes of acute abdomen (Group II) were included in the study.Full history taking, clinical examination, and laboratory investigations including urine analysis and serum levels of creatinine, random glucose, lipid profile, total and direct bilirubin, albumin, liver enzymes, total calcium, amylase, and lipase were undertaken.In addition, radiological examinations, using abdomi-nopelvic ultrasonography, computed tomography of the abdo-men and conventional X-ray when appropriate were under-taken.Urinary trypsinogen-2 was tested using dipstick.Results: We found that the most common cause of acute pancreatitis was gall stone obstructive pancreatitis (76.47%), serum amylase and lipase were elevated in (91.18% and 88.24% respectively) in acute pancreatitis.While urinary trypsinogen-2 dipstick test was positive in 100% of patients with acute pancreatitis.The specificity of serum amylase, serum lipase and urinary trypsinogen-2 in diagnosis of acute pancreatitis was (76.47%, 88.24% and 100% respectively).Conclusion: Urinary trypsinogen-2 dipstick test is a promising fast and easy test performed in the effort of diagnosis of acute pancreatitis. Further studies on large number of patients are mandatory to confirm the findings in this study.

Mo1237 - Rapid Urinary Trypsinogen Test in Early Point-of-Care Diagnosis of Acute Pancreatitis and Post-ERCP Pancreatitis: A Systematic Review

Mo1237 - Rapid Urinary Trypsinogen Test in Early Point-of-Care Diagnosis of Acute Pancreatitis and Post-ERCP Pancreatitis: A Systematic Review

Acinar cell density at the pancreatic resection margin is associated with post-pancreatectomy pancreatitis and the development of postoperative pancreatic fistula

BackgroundThere has been recent evidence supporting post-pancreatectomy pancreatitis as a factor in the development of postoperative pancreatic fistula (POPF). The aims of this study were to evaluate: (i) the correlation of the acinar cell density at the pancreatic resection margin with the intra-operative amylase concentration (IOAC) of peri-pancreatic fluid, postoperative pancreatitis, and POPF; and (ii) the association between postoperative pancreatitis on the first postoperative day and POPF. MethodsConsecutive patients who underwent pancreatic resection between June 2016 and July 2017 were included for analysis. Fluid for IOAC was collected, and amylase concentration was determined in drain fluid on postoperative days 1, 3, and 5. Serum amylase and lipase and urinary trypsinogen-2 concentrations were determined on the first postoperative day. Histology slides of the pancreatic resection margin were scored for acinar cell density. ResultsSixty-one patients were included in the analysis. Acinar cell density significantly correlated with IOAC (r = 0.566, p < 0.001), and was significantly associated with postoperative pancreatitis (p < 0.001), and POPF (p = 0.003). Postoperative pancreatitis was significantly associated with the development of POPF (OR 17.81, 95%CI 2.17–145.9, p = 0.001). DiscussionThe development of POPF may involve a complex interaction between acinar cell density, immediate leakage of pancreatic fluid, and postoperative pancreatitis.