Abstracts: Abstracts of Papers Submitted to the 36th Annual Meeting of the American Pancreatic Association, November 3-4, 2005
There are no guidelines for the diagnosis of patients with asymptomatic hyperamylasemia and/or hyperlipasemia. Therefore we investigated prospectively the incidence, causes and clinical impact of such conditions in a secondary referral center.
Patients and Methods:
During a four-month period, amylase and lipase were measured in all patients admitted to the Department of Medicine of the Municipal Clinic of Lueneburg. Patients with raised enzyme levels underwent an abdominal ultrasound (US), and, if this was inconclusive, a contrast-enhanced computed tomography (CT) and/or a magnetic resonance or endoscopic cholangiopancreatography (MRCP or ERCP).
Elevated pancreatic enzymes were found in 244 out of 1756 (14%) patients (amylase in 21 = 9%, lipase in 165 = 67%, both enzymes in 58 = 24%). In 104 (43%) patients the final diagnosis explained the enzyme elevation: acute/chronic pancreatitis, pancreatic carcinoma (n = 42) or another tumor (n = 14), biliary disease (n = 5) or renal insufficiency (n = 43). The remaining 140 (57%) patients (group 1) were asymptomatic (i.e. had no abdominal signs or symptoms indicative of acute pancreatitis). Of these 140 patients 53 (38%) did not undergo further investigations (refusal, hospital stay <24 h). In the remaining 87 patients (62%) (group 2) an US and, if necessary, a CT, MRCP or ERCP revealed pancreatic pseudocysts and/or duct irregularities indicative of silent chronic pancreatitis (SCP) in 3 (3%). Nine (10%) patients had ≥1 pancreatic cysts (all female; 8: 62-84 y; 7 pat: cysts <1 cm, 2 pat: cysts 2.2 and 2.8 cm), indicative of age-dependent fibrotic changes of the pancreas. In the remaining 77 (88%) patients the pancreas was normal. None of the patients in group 1 or 2 was readmitted for pancreatic disease during the next 6-month follow-up period.
Asymptomatic pancreatic enzyme elevation is a frequent clinical problem. In almost 90% of the cases the pancreas will be normal. In the remaining cases, the enzyme elevation may be due to clinical conditions not requiring further diagnosis or treatment (SCP) or cystic fibrotic changes of the pancreas occurring in old age. Pancreatic enzymes should be measured only in symptomatic patients in order to avoid unnecessary and expensive diagnostic procedures.