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Rapid Urine Trypsinogen-2 Test for the Early Detection of Pancreatitis in Endoscopic Sphincterotomy Patients

Nai-Hsuan Chien, Chih-Sheng Hung, Chia-Long Lee, Chi-Hwa Wu

Objective Endoscopic sphincterotomy is more invasive and time-consuming than diagnostic endoscopic retrograde cholangiopancreatography. Abdominal discomfort is also more common, and it is difficult to distinguish pain caused by pancreatitis from other procedural reasons (e.g., gas-related). We used the rapid urine trypsinogen-2 test (UT test) as a screen for early diagnosis of endoscopic sphincterotomy- related pancreatitis while reducing the frequency of taking serum samples. If an early diagnosis was made, early treatment could also be administered. Method We collected post- endoscopic sphincterotomy patient data, retrospectively, from April 2014 to November 2014. The UT would be performed 3 hours after the procedure. The serum amylase and lipase would be collected 12 hours after the procedure. The relationship among UT, pancreatic enzymes, and abdominal pain were analyzed. Results Thirty-one patients were tested in the study. Sixteen patients (51.6%) received a positive urine trypsinogen test. Ten (32.2%) and 12 (38.7%) people showed abnormal amylase and lipase levels, respectively. Two (6.4%) and 9 (29%) people exhibited amylase and lipase levels that were more than 3 times the upper limit. Six patients (19.4%) experienced post procedural abdominal pain, and 4 patients showed abnormal pancreatic enzymes. UT results were not associated with age (P=0.557), sex (0.081), or abdominal pain (0.17). In patients with elevated amylase, the sensitivity, specificity, positive predictive value, and negative predictive value of the UT were 90.0%, 66.7%, 56.3%, and 93.3% (P=0.006). In patients with elevated lipase, the sensitivity, specificity, positive predictive value, and negative predictive value of the UT were 91.7%, 73.7%, 68.8%, and 93.3% (P<0.001). In patients with amylase levels that were 3 times the upper limit, the sensitivity, specificity, positive predictive value, and negative predictive value of the UT were 100%, 51.7%, 12.5%, and 100% (P=0.484). In patients with lipase levels that were 3 times the upper limit, the sensitivity, specificity, positive predictive value, and negative predictive value of the UT were 88.9%, 63.6%, 50%, and 93.3% (P=0.016). Conclusion The rapid urine trypsinogen-2 test had high sensitivity and negative predictive value. It is useful to rule out the procedural pancreatitis with a lower frequency of taking serum samples and a high possibility of early intervention for procedure-related pancreatitis.