Diagnostic and prognostic value of CRP in post-ERCP pancreatitis

ABSTRACT

Acute pancreatitis [AP] is an inflammation 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]. 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 2[nd] and 7[th] day after ERCP. CT abdomen was performed for patients who develop post-ERCP pancreatitis. 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 T[0], T[2], T[7]. Additionally, at T[2] both serum amylase and lipase was more than 3 fold the upper limit of normal in GA. Also data concerned with CRP level at T[0], T[2], T7 revealed a significant increase in GA relative to GB. Data were highly significant at T[2] and T[7]. Out of the 25 cases of Post-ERCP pancreatitis, 17 cases showed CT findings consistent with acute pancreatitis, 13 of them had mild and moderate disease. The remaining 4 cases had severe acute pancreatitis. Since the mean value of CRP at T[7] 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 T[0], T[2], T[7] 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