P2843 - Diagnostic Accuracy of the Urine trypsinogen-2 Dipstick Test in Early Post-ERCP Pancreatitis Prediction

Itegbemie Obaitan, MD, MPH¹, Michael Rosenheck, MD¹, Hisham Wehbe, MD¹, Evan Fogel, MD¹, Aditya Gutta, MD¹, James L. Watkins, MD², Nasir Saleem, MD¹, Mark A. Gromski, MD¹, Benjamin Bick, MD, MS³, Stuart Sherman, MD¹, Jeffrey Easler, MD^2
1Indiana University School of Medicine, Indianapolis, IN; ²Indiana University, Indianapolis, IN; ³Rockford Gastroenterology Associates, Rockford, IL

Introduction: Pancreatitis is a significant complication of Endoscopic Retrograde Cholangiopancreatoscopy (ERCP), with ~25,000 reported cases in the United States annually. An inexpensive accurate pre-discharge confirmatory test for the early diagnosis of post-ERCP pancreatitis (PEP) is lacking, and this leads to unnecessary admissions for post-procedure pain that are not PEP, as well as inadvertent discharges of patients who are subsequently readmitted with PEP. The Urine Trypsinogen-2 dipstick test (UTDT) has a high sensitivity and specificity at 24 hours post-ERCP but there is limited data on the diagnostic accuracy in the immediate post-ERCP period. Our study aim is to determine the diagnostic accuracy of this test when utilized early and explore the change in test characteristics based on the pre-procedure UTDT results and presence of post-procedure abdominal pain.

Methods: Of the 396 patients with various indications for an ERCP between July 2017 and March 2020 enrolled into a prospective study database at Indiana University Health System, 254 patients met our inclusion and exclusion criteria for this cohort study. Pre- and 2-hour post-UTDT was carried out on all patients. A cut-point of < 50ug/L delineated a negative test. Follow up data was obtained at day 5 and day 30 post-procedure. Our primary outcome was PEP. Analysis was done in STATA17.

Results: The median age of our cohort was 55 years (IQR 45-64 years), with 61.8% of our cohort being female. Immediate post-ERCP abdominal pain was reported in 50.8% of patients, with 9 (3.5%) patients in our cohort developing PEP. The Pre-ERCP UTDT positivity incidence was 2.8%. The sensitivity, specificity, positive predictive value and negative predictive value of the post-ERCP UTDT were 11.1%, 91%, 4.4% and 96.5% respectively in the entire cohort, and 11.1%, 92.9%, 5.6% and 96.5% in patients with negative pre-ERCP UTDT. In patients with post-procedure abdominal pain, these characteristics were 0%, 89.3%, 0% and 94% respectively.

Discussion: Administration of the UTDT within 2 hours of ERCP lacks adequate sensitivity to be used as a pre-discharge screening test for all patients. However, when there is a strong concern for PEP it may aid an earlier admission decision. A negative pre-ERCP UTDT only marginally improves diagnostic accuracy, so pre-procedure testing is likely not required. The presence of post-ERCP abdominal pain does not improve test accuracy. Larger cohort studies of PEP patients are needed to validate these findings.


Disclosures:


Itegbemie Obaitan, MD, MPH¹, Michael Rosenheck, MD¹, Hisham Wehbe, MD¹, Evan Fogel, MD¹, Aditya Gutta, MD¹, James L. Watkins, MD², Nasir Saleem, MD¹, Mark A. Gromski, MD¹, Benjamin Bick, MD, MS³, Stuart Sherman, MD¹, Jeffrey Easler, MD². P2843 - Diagnostic Accuracy of the Urine trypsinogen-2 Dipstick Test in Early Post-ERCP Pancreatitis Prediction, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.