scholarly journals Extensive Investigation of Patients with Mild Elevations of Serum Amylase and/or Lipase Is ‘Low Yield’

2002 ◽  
Vol 16 (12) ◽  
pp. 849-854 ◽  
Author(s):  
Michael F Byrne ◽  
Robert M Mitchell ◽  
Helen Stiffler ◽  
Paul S Jowell ◽  
Malcolm S Branch ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Serum Amylase ◽  
Diagnostic Yield ◽  
Extensive Investigation ◽  
Endoscopic Retrograde ◽  
Abdominal Symptoms ◽  
Upper Limit ◽  
Pancreatic Pathology

BACKGROUND: Serum amylase and lipase levels are widely used as markers of pancreatic inflammation. However, it would seem that mild elevations of amylase and lipase rarely predict significant pancreatic pathology. Pancreatic imaging tests are expensive. The gold standard, endoscopic retrograde cholangiopancreatography, carries risk of morbidity and mortality.OBJECTIVE: To determine whether extensive investigation of patients with mild, nonspecific abdominal symptoms and mild elevations of amylase and/or lipase results in a significant diagnostic yield.METHODS: Outpatient evaluations were retrospectively analyzed over 12 months. Inclusion criteria were nonspecific abdominal pain, and mild elevations (less than three times the upper limit of normal) of serum amylase or lipase, or both. Exclusion criteria included a history of chronic pancreatitis, elevation of liver tests and acute pain syndromes.RESULTS: Nineteen patients over the study period met the criteria. Of the nineteen patients, 58% had elevation of lipase alone, 21% amylase alone and 21% had elevations of both. In addition, 89.5% of the patients had nonspecific abdominal pain. After imaging with one or more of ultrasound, computed tomography, magnetic resonance cholangiopancreatography, endoscopic ultrasound and endoscopic retrograde cholangiopancreatography, small bowel follow through or hepatobiliary scanning, 78.9% patients were thought to have a normal pancreas. Of the remaining patients, 15.8% had mild or equivocal changes of chronic pancreatitis, and one patient was found to have a pancreatic tail pseudocyst. The average cost of investigation was US$2,255, taking only direct procedural costs into account. No patient was found to have malignancy.CONCLUSIONS: The majority of patients with nonspecific abdominal pain and isolated elevations of amylase and/or lipase (less than three times the upper limit of normal) had no identifiable pancreatic pathology. The diagnostic yield in patients with mild elevations of lipase alone was particularly poor. The cost effectiveness and risk-benefit ratio of extensive investigation of this group of patients warrants further study.

scholarly journals EUS-guided fine-needle core liver biopsy with a modified one-pass, one-actuation wet suction technique comparing two types of EUS core needles

2020 ◽  
Vol 08 (07) ◽  
pp. E938-E943 ◽  
Author(s):  
Jose Nieto ◽  
Enad Dawod ◽  
Ameya Deshmukh ◽  
Eli Penn ◽  
Douglas Adler ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Liver Biopsy ◽  
Biliary Obstruction ◽  
Diagnostic Yield ◽  
Bile Leak ◽  
Specimen Length ◽  
Intact Specimen ◽  
Medical Centers ◽  
Post Procedure ◽  
Pancreatic Pathology

Abstract Background and study aims We compared the diagnostic yield and specimen adequacy in EUS-guided parenchymal biopsies between two types of EUS 19 G core needles. Patients and methods This is a retrospective study of 420 patients at two tertiary medical centers in Florida with unexplained abnormal liver associated tests were referred for EUS evaluation of biliary obstruction and pancreatic pathology. EUS-guided liver biopsy (EUS-LB) was performed at the same session after biliary obstruction was excluded. We compared intact specimen length (ISL), total specimen length (TSL), complete portal triads (CPT) and adverse events (AE). Welch’s T and Tukey tests were used for ISL, TSL and CPT. Results A total of 210 patients underwent EUS-LB using a Franseen needle, 210 patients using a fork-tip needle. Median patient age was 52 years (15.63) and 238 (56.7 %) were female. The fork-tip needle had a mean ISL of 2.7 (1.1 SD) cm, TSL of 6 cm (2.1 SD), and mean 19.5 CPT (8.5 SD) Abdominal pain occurred in 35 patients (17 %) post-procedure and was managed with supportive care. Two patients required intravenous (IV) narcotic administration. Subcapsular hematomas occurred in 1 (0.5 %) patients. The Franseen needle had a mean ISL of 3.1 cm (1.3 SD), TSL of 6.5 cm (2.6 SD), and mean of 24 CPT (8.8 SD). Abdominal pain occurred in four patients (2 %) post-procedure, which resolved in all patients after IV narcotic administration. Subcapsular hematomas occurred in 1 (0.5 %) and bile leak in 1(0.4 %) patients. Conclusions Use of the Franseen needle resulted in better liver core samples than that obtained with a fork-tip needle.

Acute pancreatitis

2010 ◽  
pp. 2557-2567
Author(s):  
R. Carter ◽  
C.J. McKay
Keyword(s):  
Acute Pancreatitis ◽  
Peptic Ulcer ◽  
Gastric Ulcer ◽  
Abdominal Pain ◽  
Serum Amylase ◽  
Perforated Peptic Ulcer ◽  
Upper Limit ◽  
Abdominal Emergencies ◽  
Idiopathic Acute Pancreatitis ◽  
Upper Abdominal

Acute pancreatitis affects 300 to 600 new patients per million population per year and is most commonly caused by gallstones or alcohol, but there are many other causes and associations. Careful imaging reveals that most so-called idiopathic acute pancreatitis is due to small (1–3 mm diameter) gallstones. Diagnosis is made by a combination of a typical presentation (upper abdominal pain and vomiting) in conjunction with raised serum amylase (> × 3 upper limit of normal) and/or lipase (> × 2 upper limit of normal). Several acute abdominal emergencies can mimic acute pancreatitis and may be associated with a raised serum amylase. These include perforated peptic ulcer (particularly perforated posterior gastric ulcer) and acute mesenteric ischaemia. In equivocal cases, a CT scan is indicated in order to exclude other causes and confirm the diagnosis....

scholarly journals Pancreaticoportal Fistula in Association with Antiphospholipid Syndrome Presenting as Ascites and Portal System Thrombosis

2002 ◽  
Vol 16 (9) ◽  
pp. 601-605 ◽  
Author(s):  
Li-Hsin Chang ◽  
Luc Francoeur ◽  
Franzjosef Schweiger
Keyword(s):  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Medical Therapy ◽  
Antiphospholipid Syndrome ◽  
Portal System ◽  
Pancreatic Pseudocysts ◽  
Portal Venous System ◽  
Laboratory Studies ◽  
Endoscopic Retrograde ◽  
Computed Tomographic

Fistulous communication between the pancreas and the portal venous system is extremely rare and is usually a complication of chronic pancreatitis or pancreatic pseudocysts. A patient who presented with abdominal pain and ascites secondary to a pancreaticoportal fistula and portal system thrombosis is described. The diagnosis was made by endoscopic retrograde cholangiopancreatography and confirmed by immediate postprocedure computed tomographic scanning. Laboratory studies identified concomitant antiphospholipid syndrome. The patient responded favourably to supportive medical therapy.

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