Determination of elastase-1 serum levels in post ERCP/EST pancreatic damage

Recently an ELISA using specific antibodies to detect elastase-1 in serum has become available. Earlier studies using a radioimmunoassay reported a prolonged elevation of serum elastase as compared to other pancreatic enzymes in acute pancreatitis. The aim of the present study was to compare the changes of serum levels of ELISA-elastase-1, lipase and amylase in acute pancreatic damage following ERCP. Blood samples were prospectively collected at five time points before and after the endoscopic procedures in 212 patients. Samples were analyzed for pancreatic serum enzymes, acute phase proteins and routine parameters. A pain score was used for clinical evaluation. Relevant post ERCP pancreatic damage was defined as CRP elevation from < 10 mg/l to > 10 mg/l in the presence of persistent abdominal pain without laboratory evidence of cholangitis and without clinical or laboratory signs of pancreatitis before the endoscopic procedures. Elastase-1 time course paralleled the courses of lipase and amylase peeking at six hrs. There was no prolonged elevation of elastase-1. Ten out of 204 patients (4.9%) were found to have relevant pancreatic damage. Depending on the cut off point used, sensitivity/specificity were as follows: lipase 80-100%/30.9-71.6%; amylase 70-90%/44.3-88.7%; elastase-1 60-90%/64.9-81.4%. In conclusion ELISA-elastase-1 is a marker of acute pancreatic damage similar to lipase and amylase. Although elastase-1 may show a better specificity than the other enzymes, this seems to be a matter of definition of the normal range. The determination of serum ELISA-elastase-1 does not provide additional information in acute pancreatic damage as compared to a combination of lipase and amylase.