Читать книгу Clinical Pancreatology for Practising Gastroenterologists and Surgeons - Группа авторов - Страница 38

AP is the most common complication of ERCP. Transient hyperamylasemia occurs in up to 75% of patients after ERCP without abdominal pain. Hence, AP should be considered in patients with clinical evidence of pancreatitis in the presence of elevated (at least three times the upper limit of normal) serum amylase/lipase level at 24 hours post ERCP and requiring admission or prolongation of planned admission to two to three days [56]. Based on this definition, the incidence of post‐ERCP pancreatitis is 3–10% in systematic reviews [57–59]. A four‐ or six‐hour amylase/lipase level of more than four to five times the upper limit of normal can also predict post‐ERCP pancreatitis with high sensitivity and specificity [60]. Perforation is an important differential diagnosis and there should be a low threshold to perform abdominal CT with oral contrast if there is a suspicion of perforation as a differential diagnosis as it is the most sensitive and specific test [61,62].

Independent patient‐ and procedure‐related risk factors act synergistically in post‐ERCP pancreatitis (Table 2.3).