{
  "abstract": "Background The diagnosis of acute pancreatitis is established based on 2 out of the 3 following criteria – clinical (upper abdominal pain), biochemical (serum amylase or lipase levels greater than three times upper limit of normal) and radiological imaging (CT/MRI or ultrasound). 1 Studies have shown that serum amylase and lipase have a sensitivity of 61%-70% and 80-85% respectively and specificity approaching 90%-95% for both.2 In UK, serum amylase is most frequently used as the primary test to diagnose acute pancreatitis as this is more widely available and a cheaper test. In our hospital, patients with initial abnormal amylase result only proceeds to serum lipase using the same sample. This may have diagnostic implications. We share our experience from a busy teaching district general hospital in the UK.Aim To evaluate the diagnostic performance of serum amylase and lipase in patients with suspected acute pancreatitis and to co-relate biochemical findings with imaging, final diagnosis and clinical outcomes.Methods We conducted a retrospective observational study of all adult patients who presented to the Emergency Department (ED) and Same Day Emergency Care (SDEC) unit between 1st March and 1st May 2025. A total of 1,360 patients, who underwent serum amylase and/or lipase for abdominal pain and suspected acute pancreatitis, were identified from the electronic WebICE system and patient care records. Data collected included patient demographic, presenting complaint, biochemical markers (serum amylase and lipase levels), radiological findings (CT, Ultrasound, MRCP), final diagnosis, disease severity, and duration of hospital stay.Results A total of 1,360 patients underwent pancreatic enzyme testing; 119 (8.8%) had elevated amylase and/or lipase levels. Acute pancreatitis (AP) was confirmed in 60 patients (50%), while 59 had alternative diagnoses ( table 1). Serum lipase demonstrated superior diagnostic performance compared with amylase, with sensitivity 100% vs 71.7%, negative predictive value 100% vs 77.6%, and overall diagnostic accuracy 96.6% vs 85.7%, respectively. However, serum amylase performed better compared to lipase in regards to specificity (100% vs 93.2%) and positive predictive value (100% vs 93.8%). No cases of AP were identified in the sub-group of patients with normal enzyme levels who underwent cross-sectional imaging performed for excluding other conditions. Adding lipase to an amylase-first protocol resulted in a 28.3% absolute gain in sensitivity, identifying 17 cases of AP missed by amylase alone, whereas amylase provided no incremental diagnostic benefit when added to lipase. Despite higher per-test costs, (£0.64 for lipase vs £0.09 for amylase) a lipase-only strategy may be cost-effective by preventing missed diagnoses of acute pancreatitis and avoid wasting of resources.Conclusion Our study shows that serum lipase has a higher sensitivity, diagnostic accuracy and negative predictive value compared to amylase. Our data suggests that an amylase-first or dual-testing protocol is clinically inferior. Transitioning to a lipase-only primary testing strategy improves diagnostic yield, ensures no cases are missed (100% NPV). Our findings highlight that test cost alone should not dictate diagnostic strategy but rather, diagnostic accuracy and downstream clinical and economic consequences must be considered.References IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2025. S1424-3903(25)00085-7. doi: 10.1016/j.pan.2025.04.020.Rompianesi G, Hann A, Komolafe O, Pereira SP, Davidson BR, Gurusamy KS. Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis. Cochrane Database Syst Rev. 2017;4(4):CD012010Abstract FP41 Table 1Diagnosis frequency and percentageAcute Pancreatitis (AP)n (%)Alternative Diagnosesn (%)Biliary pancreatitis36 (30.8)Chronic pancreatitis 8 (6.7)Idiopathic pancreatitis11 (9.2)Acute gastritis8 (6.7)Alcohol-induced pancreatitis8 (6.7)Gastroenteritis5 (4.2)Acute on chronic pancreatitis4 (3.3)Urinary tract infection4 (3.3)Autoimmune pancreatitis1 (0.8)Pneumonia3 (2.5)Total AP60 (50.4)Other diagnoses*31 (26.0)Total non-AP59 (49.5)*Other diagnoses included biliary disease, gastrointestinal, infective, cardiovascular, surgical, and miscellaneous non-pancreatic conditions (each ≤2 cases).",
  "authors": [
    {
      "affiliations": [
        "Gastroenterology department, University Hospital of NorthTees, Stockton-on-tees, United Kingdom"
      ],
      "name": "Mahmoud Mohamed"
    },
    {
      "affiliations": [
        "Gastroenterology department, University Hospital of NorthTees, Stockton-on-tees, United Kingdom"
      ],
      "name": "Mohamed Mohammed"
    },
    {
      "affiliations": [
        "Department of Biochemistry, University Hospital of North Tees, Stockton-on-tees, United Kingdom"
      ],
      "name": "Harish Datta"
    },
    {
      "affiliations": [
        "Gastroenterology department, University Hospital of NorthTees, Stockton-on-tees, United Kingdom"
      ],
      "name": "Laura O’Rourke"
    },
    {
      "affiliations": [
        "Gastroenterology department, University Hospital of NorthTees, Stockton-on-tees, United Kingdom"
      ],
      "name": "Liz Baker"
    },
    {
      "affiliations": [
        "Department of Biochemistry, University Hospital of North Tees, Stockton-on-tees, United Kingdom"
      ],
      "name": "Jayanthi Rajasekar"
    },
    {
      "affiliations": [
        "Department of Biochemistry, University Hospital of North Tees, Stockton-on-tees, United Kingdom"
      ],
      "name": "Helen Verrill"
    },
    {
      "affiliations": [
        "Gastroenterology department, University Hospital of NorthTees, Stockton-on-tees, United Kingdom"
      ],
      "name": "Vikramjit Mitra"
    }
  ],
  "title": "FP41 Utility of serum amylase and lipase in patients presenting with suspected acute pancreatitis: retrospective study from an acute hospital setting",
  "uid": "ddc22efc-663b-548d-bb64-ac0afe4a3069"
}