What diagnostic screening is recommended for pancreatitis?

From the Guidelines

Diagnostic screening for pancreatitis should include blood tests, such as serum amylase and lipase levels, as well as imaging studies like abdominal ultrasound and contrast-enhanced CT scan, with the latter being performed 48-72 hours after symptom onset for optimal visualization of pancreatic necrosis. The diagnosis of acute pancreatitis should be established within 48 hours of admission, based on compatible clinical features and elevations in amylase or lipase levels, with elevations greater than 3 times the upper limit of normal being most consistent with acute pancreatitis 1.

Blood Tests

Blood tests should include:

• Serum amylase and lipase levels, which are usually elevated to at least three times the normal limit in acute pancreatitis
• Complete blood count, metabolic panel, liver function tests, and triglyceride levels to assess severity and identify potential causes
• C-reactive protein level, hematocrit, urea, and procalcitonin levels can be used as prognostic factors for severe acute pancreatitis and detection of pancreatic infection 1

Imaging Studies

Imaging studies are essential, with:

• Abdominal ultrasound being the first-line test to evaluate for gallstones, a common cause of pancreatitis
• Contrast-enhanced CT scan recommended for patients with severe symptoms or when the diagnosis is uncertain, typically performed 48-72 hours after symptom onset for optimal visualization of pancreatic necrosis
• MRI or magnetic resonance cholangiopancreatography (MRCP) may be used when CT is contraindicated or to better evaluate the pancreatic and biliary ducts
• Endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP) might be performed in cases of recurrent pancreatitis with unclear etiology 1

Diagnostic Approach

The diagnostic approach should be based on the clinical presentation and laboratory findings, with a focus on determining the cause and severity of pancreatitis. The 2019 WSES guidelines for the management of severe acute pancreatitis recommend the use of a determinant-based classification system to categorize patients with mild, moderate, or severe acute pancreatitis 1.

Recent Guidelines

Recent guidelines, such as the 2019 WSES guidelines and the AGA clinical practice update, emphasize the importance of a multidisciplinary approach to the diagnosis and management of pancreatitis, with a focus on early recognition and treatment of severe cases 1. The use of endoscopic ultrasound as the preferred diagnostic test for unexplained acute and recurrent pancreatitis is recommended, with magnetic resonance imaging with contrast and cholangiopancreatography as a reasonable complementary or alternative test 1.

From the Research

Diagnostic Screening for Pancreatitis

The diagnostic screening for pancreatitis typically involves a combination of clinical evaluation, laboratory tests, and imaging studies. The following are some of the key diagnostic screening methods for pancreatitis:

• Laboratory tests:
  • Serum amylase and lipase levels: These are the most commonly used laboratory tests for diagnosing pancreatitis 2, 3, 4, 5, 6.
  • Other enzymes such as trypsinogen, elastase, and pancreatic isoamylase may also be used, but they are not as commonly used as amylase and lipase 3, 4, 6.
• Imaging studies:
  • Ultrasonography (US): This is useful for evaluating the biliary tract in patients with pancreatitis 3.
  • Computed tomography (CT): This is useful for estimating the presence and extent of pancreatic necrosis and for identifying patients at high risk for systemic and local complications 3.
• Clinical evaluation:
  • Characteristic abdominal pain: This is a key symptom of pancreatitis, and patients typically present with severe, persistent abdominal pain 5.
  • Radiological evidence of pancreatitis: This can include findings such as pancreatic enlargement, necrosis, or fluid collections 5.

Recommended Diagnostic Approach

The recommended diagnostic approach for pancreatitis typically involves a combination of laboratory tests, imaging studies, and clinical evaluation. The following are some of the key recommendations:

• Serum lipase is now the preferred test due to its improved sensitivity, particularly in alcohol-induced pancreatitis 2, 5.
• A threshold concentration 2-4 times the upper limit of normal is recommended for diagnosis 5.
• Ultrasonography and CT scans can be useful for evaluating the biliary tract and estimating the presence and extent of pancreatic necrosis 3.
• Clinical evaluation, including characteristic abdominal pain and radiological evidence of pancreatitis, is also important for diagnosing pancreatitis 5.