Diagnostic and Prognostic Value of CRP in Post-ERCP Pancreatitis
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- Category: Vol. 77, March 2009
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Diagnostic and Prognostic Value of CRP in Post-ERCP Pancreatitis,AHMAD T. SAYED, EMAD M. EL-MOATASEM and HATEM A. DARWISH
Abstract
Background and Aim: Acute pancreatitis (AP) is an in-flammation of the pancreas secondary to a variety of causes. It is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP). As most ERCP is performed on an outpatient base, early evaluation can allow safe discharge of the majority of patients. The aim of this study was to identify the value of C-reactive protein (CRP) in the diagnosis and prognosis of post-ERCP pancreatitis (PEP).
Methods: One hundred patients who were candidate for ERCP examination either diagnostic or therapeutic included in the present study. All patients has been followed-up daily for at least 48 hours after ERCP for symptoms and signs suggestive of post-ERCP pancreatitis and follow-up of post ERCP pancreatitis patients has been done until pancreatic enzymes and CRP became normal. Serum amylase, lipase and CRP were done immediately after ERCP and on 2nd and 7th day after ERCP. CT` abdomen was performed for patients who develop post-ERCP pancreatitis.
Results: Patients were divided into group A (GA) which developed post-ERCP pancreatitis [25 patients (25%)] and group B (GB) which had no pancreatitis [75 patients (75%)]. Serum amylase and lipase were significantly higher in GA relative to GB at T0, T2, T7. Additionally, at T2 both serum amylase and lipase was more than 3 fold the upper limit of normal in GA. Also data concerned with CRP level at T0, T2, T7 revealed a significant increase in GA relative to GB. Data were highly significant at T2 and T7. Out of the 25 cases of Post-ERCP pancreatitis, 17 cases showed CT findings consis-tent with acute pancreatitis, 13 of them had mild and moderate disease. The remaining 4 cases had severe acute pancreatitis.
Conclusion: Since the mean value of CRP at T7 in GA is still high above upper limit of normal, while serum amylase and lipase were not, and the significant rise in CRP level at T0, T2, T7 in GA was directly correlated to the CT findings. Therefore, these data might suggest the importance of the CRP level as a diagnostic test and also in the assessment of the prognosis of Post-ERCP Pancreatitis, it is cheap, readily available but it is not an early marker.