Rapid trypsinogen-2 test and post ERCP discharge Strategy - EJGH Nov 26

The study "Rapid trypsinogen-2 test and post-ERCP discharge strategy" published in the European Journal of Gastroenterology & Hepatology (EJGH) on November 26 explores methods to predict adverse events (AEs) following endoscopic retrograde cholangiopancreatography (ERCP). It examines the effectiveness of two strategies: the urinary trypsinogen-2 (UT-2) dipstick test and a risk-factor-based discharge tool, both individually and in combination, to identify patients at high risk of post-ERCP AEs.

Background and Problem Statement:

ERCP is associated with a significant risk of adverse events, including post-ERCP pancreatitis, infections, bleeding, and perforation, with an approximate 10% incidence rate. Current post-ERCP discharge strategies, such as those recommended by the European Society of Gastrointestinal Endoscopy (ESGE), rely on serum amylase or lipase measurements 2–6 hours after the procedure. However, these strategies have limitations:

1. They do not account for AEs other than pancreatitis.

2. They are logistically burdensome, requiring blood sampling, laboratory testing, and additional hospital resources.

3. Post-ERCP hyperamylasemia is common in asymptomatic patients, leading to potential overestimation of risk.

The study aimed to evaluate whether the UT-2 dipstick test, the discharge tool, or their combination could serve as simpler, more efficient alternatives for predicting post-ERCP AEs and guiding discharge decisions.

Results:

The study enrolled 268 patients across multiple hospitals from August 2018 to March 2021. Key findings include:

• Adverse Events (AEs): 10.5% of patients experienced AEs, with 6.1% developing post-ERCP pancreatitis.
• Combined Strategy Performance: The combination of the UT-2 dipstick test and the discharge tool outperformed individual strategies for predicting AEs, with a sensitivity of 66.7%, specificity of 78.5%, positive predictive value (PPV) of 26.6%, and negative predictive value (NPV) of 95.3%.
• For post-ERCP pancreatitis specifically, the combined strategy had a sensitivity of 64.3%, specificity of 76.2%, PPV of 14.9%, and NPV of 97.0%.

Conclusion:

While the combined approach of the UT-2 dipstick test and the discharge tool showed improved predictive accuracy compared to individual strategies, its overall sensitivity remained suboptimal. As a result, the study does not recommend the implementation of either strategy—individually or combined—as a replacement for current post-ERCP discharge protocols. The findings highlight the need for further research to develop reliable, cost-effective, and logistically feasible tools for predicting post-ERCP adverse events.