Extensive investigation of patients with mild elevations of serum amylase and/or lipase is 'low yield'

Michael F. Byrne, Robert M. Mitchell, Helen Stiffler, Paul S. Jowell, Malcolm S. Branch, Theodore N. Pappas, Douglas Tyler, John Baillie

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

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 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.

Original languageEnglish (US)
Pages (from-to)849-854
Number of pages6
JournalCanadian Journal of Gastroenterology
Volume16
Issue number12
StatePublished - Dec 1 2002
Externally publishedYes

Fingerprint

Amylases
Lipase
Serum
Abdominal Pain
Endoscopic Retrograde Cholangiopancreatography
Chronic Pancreatitis
Magnetic Resonance Cholangiopancreatography
Pathology
Pancreatic Pseudocyst
Costs and Cost Analysis
Acute Pain
Cost-Benefit Analysis
Pancreas
Outpatients
Odds Ratio
Tomography
Inflammation
Morbidity
Mortality

Keywords

  • Amylase
  • Lipase
  • Low yield
  • Mild elevations
  • Pancreas

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Byrne, M. F., Mitchell, R. M., Stiffler, H., Jowell, P. S., Branch, M. S., Pappas, T. N., ... Baillie, J. (2002). Extensive investigation of patients with mild elevations of serum amylase and/or lipase is 'low yield'. Canadian Journal of Gastroenterology, 16(12), 849-854.

Extensive investigation of patients with mild elevations of serum amylase and/or lipase is 'low yield'. / Byrne, Michael F.; Mitchell, Robert M.; Stiffler, Helen; Jowell, Paul S.; Branch, Malcolm S.; Pappas, Theodore N.; Tyler, Douglas; Baillie, John.

In: Canadian Journal of Gastroenterology, Vol. 16, No. 12, 01.12.2002, p. 849-854.

Research output: Contribution to journalArticle

Byrne, MF, Mitchell, RM, Stiffler, H, Jowell, PS, Branch, MS, Pappas, TN, Tyler, D & Baillie, J 2002, 'Extensive investigation of patients with mild elevations of serum amylase and/or lipase is 'low yield'', Canadian Journal of Gastroenterology, vol. 16, no. 12, pp. 849-854.
Byrne MF, Mitchell RM, Stiffler H, Jowell PS, Branch MS, Pappas TN et al. Extensive investigation of patients with mild elevations of serum amylase and/or lipase is 'low yield'. Canadian Journal of Gastroenterology. 2002 Dec 1;16(12):849-854.
Byrne, Michael F. ; Mitchell, Robert M. ; Stiffler, Helen ; Jowell, Paul S. ; Branch, Malcolm S. ; Pappas, Theodore N. ; Tyler, Douglas ; Baillie, John. / Extensive investigation of patients with mild elevations of serum amylase and/or lipase is 'low yield'. In: Canadian Journal of Gastroenterology. 2002 ; Vol. 16, No. 12. pp. 849-854.
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