A prospective trial on the correllation of consensus definition of post-ERCP pancreatitis, CT findings and clinical diagnosis of pancreatitis: are the old concepts coming down?

ABSTRACT

Background: The consensus definition of post-ERCP pancreatitis is abdominal pain 24 hours following ERCP along with greater than 3-fold serum amylase eleva»tion. The authors evaluated if there was a correlation between the consensus definition and CT findings of pancreatitis. Methods: 300 patients were followed pro»spectively after ERCP regarding development of pan»creatitis. Patients developing pain underwent amylase testing and abdominal CT scan. Pancreatitis on CT was classified by the Balthazar classification. The pri»mary outcome measurement was the correlation be»tween the consensus definition of post-ERCP pancre»atitis and CT findings of pancreatitis. Results: Out of the patients submitted to the study, 49 presented ab»dominal pain in the 24 hours following examination. Of these, 38 (12.6%) had radiological alterations com-patible with pancreatitis and 23 (7.6%) a > 3-fold serum amylase elevation. Selective cannulation of the biliary duct with guidewire revealed a lower incidence (p = 0.037) and severity (p = 0.002) of pancreatites than cannulation without guidewire. Ali patients had a low-intensity pancreatitis according to Ranson's cri»teria. There were no procedure-related deaths. Con»clusions The best parameter for the diagnosis of post»ERCP pancreatitis is the tomographic control before and after the procedure, with amylase elevation (three times) having 52.6% sensitivity, 72.7% specificity and 57.1% accuracy.