Rapid resolution of high level hyperamylasemia as a guide to clinical diagnosis and timing of surgical treatment in patients with gallstones.

We reviewed the charts of 78 patients with acute hyperamylasemia (25 with gallstones, 38 alcoholic patients and 15 other), looking for early patterns of serum amylase flux that could distinguish gallstone associated disease. Patients with gallstones had average serum amylase levels of 1,848 +/- 289 International units per liter and 911 +/- 233 International units per liter at hospital admission and on hospital day 2, respectively; these levels were significantly greater than those in either the alcoholic or other patients. In the group of patients with gallstones, there were also dramatic decreases in serum levels of amylase at 24 hours (1,425 +/- 286 International units) after hospital admission; these decreases were not seen in the other groups of patients. At operation, the patients with gallstones had mild or no pancreatitis. All of them underwent uneventful cholecystectomy within 48 hours of hospitalization; only three patients required exploration of the common duct, and only one patient had ampullary obstruction. We conclude that rapid resolution of high level hyperamylasemia within 24 hours of hospitalization in symptomatic patients with gallstones can help to identify patients whose amylase fluctuations are indeed gallstone related, who have either mild pancreatitis or none at all, are good candidates for early cholecystectomy and are not likely to have common duct stones.