Low Serum Trypsin Levels Predict Deep Pancreatic Cannulation Failure during Endoscopic Retrograde Cholangiopancreatography in Patients with Symptomatic Obstructive Chronic Pancreatitis

Mahya Faghih, Tina Boortalary, Niloofar Y. Jalaly, Olaya I. Brewer Gutierrez, Yen I. Chen, Javad R. Azadi, Nasim Parsa, Michaël Noë, Christopher Fan, Vivek Kumbhari, Anthony N Kalloo, Atif Zaheer, Mouen Khashab, Vikesh Singh

Research output: Contribution to journalArticle

Abstract

Deep pancreatic cannulation (DPC) failure during endoscopic retrograde cholangiopancreatography (ERCP) in patients with chronic pancreatitis (CP) can occur in the presence of ductal obstruction due to strictures and/or stones. There are currently no simple preprocedure clinical or laboratory tests that can predict DPC failure during ERCP. Methods All adult patients with definite CP by M-ANNHEIM criteria referred to the pancreatitis clinic between 2010 and 2017 were evaluated. Serum trypsin levels were obtained to assess the morphologic severity of disease and/or exocrine insufficiency. Univariable and multivariable logistic regression analyses were performed to identify factors associated with DPC failure. Results There were 346 patients, of whom 100 underwent trypsin measurements and ERCP for symptomatic CP. Deep pancreatic cannulation failure occurred in 32 (32%). There were no significant differences with regard to age, sex, etiology, smoking, and alcohol use. Deep pancreatic cannulation failure was more likely to occur in patients with low trypsin levels (53.1% vs 25%, P = 0.007) compared with those with successful DPC. Low trypsin levels were independently associated with DPC failure in adjusted analysis (odds ratio, 3.7; 95% confidence interval, 1.2-11; P = 0.02). Conclusions Low serum trypsin levels independently predict DPC failure during ERCP in patients with symptomatic obstructive CP.

Original languageEnglish (US)
Pages (from-to)844-849
Number of pages6
JournalPancreas
Volume48
Issue number6
DOIs
StatePublished - Jul 1 2019

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Endoscopic Retrograde Cholangiopancreatography
Chronic Pancreatitis
Catheterization
Trypsin
Serum
Pancreatitis
Pathologic Constriction
Logistic Models
Smoking
Odds Ratio
Regression Analysis
Alcohols
Confidence Intervals

Keywords

  • endoscopic retrograde cholangiopancreatography
  • pancreatitis
  • trypsin assay

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

Cite this

Low Serum Trypsin Levels Predict Deep Pancreatic Cannulation Failure during Endoscopic Retrograde Cholangiopancreatography in Patients with Symptomatic Obstructive Chronic Pancreatitis. / Faghih, Mahya; Boortalary, Tina; Jalaly, Niloofar Y.; Brewer Gutierrez, Olaya I.; Chen, Yen I.; Azadi, Javad R.; Parsa, Nasim; Noë, Michaël; Fan, Christopher; Kumbhari, Vivek; Kalloo, Anthony N; Zaheer, Atif; Khashab, Mouen; Singh, Vikesh.

In: Pancreas, Vol. 48, No. 6, 01.07.2019, p. 844-849.

Research output: Contribution to journalArticle

Faghih, Mahya ; Boortalary, Tina ; Jalaly, Niloofar Y. ; Brewer Gutierrez, Olaya I. ; Chen, Yen I. ; Azadi, Javad R. ; Parsa, Nasim ; Noë, Michaël ; Fan, Christopher ; Kumbhari, Vivek ; Kalloo, Anthony N ; Zaheer, Atif ; Khashab, Mouen ; Singh, Vikesh. / Low Serum Trypsin Levels Predict Deep Pancreatic Cannulation Failure during Endoscopic Retrograde Cholangiopancreatography in Patients with Symptomatic Obstructive Chronic Pancreatitis. In: Pancreas. 2019 ; Vol. 48, No. 6. pp. 844-849.
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abstract = "Deep pancreatic cannulation (DPC) failure during endoscopic retrograde cholangiopancreatography (ERCP) in patients with chronic pancreatitis (CP) can occur in the presence of ductal obstruction due to strictures and/or stones. There are currently no simple preprocedure clinical or laboratory tests that can predict DPC failure during ERCP. Methods All adult patients with definite CP by M-ANNHEIM criteria referred to the pancreatitis clinic between 2010 and 2017 were evaluated. Serum trypsin levels were obtained to assess the morphologic severity of disease and/or exocrine insufficiency. Univariable and multivariable logistic regression analyses were performed to identify factors associated with DPC failure. Results There were 346 patients, of whom 100 underwent trypsin measurements and ERCP for symptomatic CP. Deep pancreatic cannulation failure occurred in 32 (32{\%}). There were no significant differences with regard to age, sex, etiology, smoking, and alcohol use. Deep pancreatic cannulation failure was more likely to occur in patients with low trypsin levels (53.1{\%} vs 25{\%}, P = 0.007) compared with those with successful DPC. Low trypsin levels were independently associated with DPC failure in adjusted analysis (odds ratio, 3.7; 95{\%} confidence interval, 1.2-11; P = 0.02). Conclusions Low serum trypsin levels independently predict DPC failure during ERCP in patients with symptomatic obstructive CP.",
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author = "Mahya Faghih and Tina Boortalary and Jalaly, {Niloofar Y.} and {Brewer Gutierrez}, {Olaya I.} and Chen, {Yen I.} and Azadi, {Javad R.} and Nasim Parsa and Micha{\"e}l No{\"e} and Christopher Fan and Vivek Kumbhari and Kalloo, {Anthony N} and Atif Zaheer and Mouen Khashab and Vikesh Singh",
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T1 - Low Serum Trypsin Levels Predict Deep Pancreatic Cannulation Failure during Endoscopic Retrograde Cholangiopancreatography in Patients with Symptomatic Obstructive Chronic Pancreatitis

AU - Faghih, Mahya

AU - Boortalary, Tina

AU - Jalaly, Niloofar Y.

AU - Brewer Gutierrez, Olaya I.

AU - Chen, Yen I.

AU - Azadi, Javad R.

AU - Parsa, Nasim

AU - Noë, Michaël

AU - Fan, Christopher

AU - Kumbhari, Vivek

AU - Kalloo, Anthony N

AU - Zaheer, Atif

AU - Khashab, Mouen

AU - Singh, Vikesh

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Y1 - 2019/7/1

N2 - Deep pancreatic cannulation (DPC) failure during endoscopic retrograde cholangiopancreatography (ERCP) in patients with chronic pancreatitis (CP) can occur in the presence of ductal obstruction due to strictures and/or stones. There are currently no simple preprocedure clinical or laboratory tests that can predict DPC failure during ERCP. Methods All adult patients with definite CP by M-ANNHEIM criteria referred to the pancreatitis clinic between 2010 and 2017 were evaluated. Serum trypsin levels were obtained to assess the morphologic severity of disease and/or exocrine insufficiency. Univariable and multivariable logistic regression analyses were performed to identify factors associated with DPC failure. Results There were 346 patients, of whom 100 underwent trypsin measurements and ERCP for symptomatic CP. Deep pancreatic cannulation failure occurred in 32 (32%). There were no significant differences with regard to age, sex, etiology, smoking, and alcohol use. Deep pancreatic cannulation failure was more likely to occur in patients with low trypsin levels (53.1% vs 25%, P = 0.007) compared with those with successful DPC. Low trypsin levels were independently associated with DPC failure in adjusted analysis (odds ratio, 3.7; 95% confidence interval, 1.2-11; P = 0.02). Conclusions Low serum trypsin levels independently predict DPC failure during ERCP in patients with symptomatic obstructive CP.

AB - Deep pancreatic cannulation (DPC) failure during endoscopic retrograde cholangiopancreatography (ERCP) in patients with chronic pancreatitis (CP) can occur in the presence of ductal obstruction due to strictures and/or stones. There are currently no simple preprocedure clinical or laboratory tests that can predict DPC failure during ERCP. Methods All adult patients with definite CP by M-ANNHEIM criteria referred to the pancreatitis clinic between 2010 and 2017 were evaluated. Serum trypsin levels were obtained to assess the morphologic severity of disease and/or exocrine insufficiency. Univariable and multivariable logistic regression analyses were performed to identify factors associated with DPC failure. Results There were 346 patients, of whom 100 underwent trypsin measurements and ERCP for symptomatic CP. Deep pancreatic cannulation failure occurred in 32 (32%). There were no significant differences with regard to age, sex, etiology, smoking, and alcohol use. Deep pancreatic cannulation failure was more likely to occur in patients with low trypsin levels (53.1% vs 25%, P = 0.007) compared with those with successful DPC. Low trypsin levels were independently associated with DPC failure in adjusted analysis (odds ratio, 3.7; 95% confidence interval, 1.2-11; P = 0.02). Conclusions Low serum trypsin levels independently predict DPC failure during ERCP in patients with symptomatic obstructive CP.

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