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 recommended for patients with severe symptoms or diagnostic uncertainty, as supported by the most recent guidelines 1. The diagnostic approach to pancreatitis involves a combination of clinical evaluation, laboratory tests, and imaging studies. Blood tests should include serum amylase and lipase levels, which are usually elevated to at least three times the upper limit of normal in acute pancreatitis. Other recommended laboratory tests include complete blood count, metabolic panel, liver function tests, triglyceride levels, and calcium levels to assess severity and identify potential causes. Imaging studies are essential in the diagnosis of pancreatitis, with abdominal ultrasound being the first-line test to evaluate for gallstones, a common cause of pancreatitis.

• Ultrasound is valuable in detecting free peritoneal fluid, gallstones, dilatation of the common bile duct, and occasionally other pathology such as abdominal aortic aneurysm, as noted in earlier guidelines 1.
• However, the most recent and highest quality study recommends the use of endoscopic ultrasound as the preferred diagnostic test for unexplained acute and recurrent pancreatitis, with magnetic resonance imaging with contrast and cholangiopancreatography as a reasonable complementary or alternative test 1. Contrast-enhanced CT scan is recommended for patients with severe symptoms, diagnostic uncertainty, or those not improving after 48-72 hours of treatment, as it can detect pancreatic necrosis and complications.
• The optimal timing for the first contrast-enhanced CT assessment is 72–96 hours after the onset of symptoms, as stated in the 2019 WSES guidelines for the management of severe acute pancreatitis 1. MRI or magnetic resonance cholangiopancreatography (MRCP) may be used when CT is contraindicated or to better visualize the pancreatic and biliary ducts.
• In cases of recurrent pancreatitis with unclear etiology, endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP) might be performed for detailed imaging and potential therapeutic intervention, as suggested by the AGA clinical practice update on the endoscopic approach to recurrent acute and chronic pancreatitis 1. These tests are crucial for confirming the diagnosis, determining the cause, assessing severity, and guiding appropriate treatment for pancreatitis.
• The cut-off value of serum amylase and lipase is normally defined to be three times the upper limit, and C-reactive protein level, hematocrit, urea, and procalcitonin can be used as prognostic factors for severe acute pancreatitis, as indicated in the 2019 WSES guidelines 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.