It is unknown whether drain fluid amylase should be used as a testing method for pancreatic leak after pancreatic resection, according to a Cochrane review of 5 studies involving 868 individuals. The optimal cut-off of drain fluid amylase for making the diagnosis of pancreatic leak is also not clear. Among the findings:

• The way that study authors confirmed that a participant had or did not have pancreatic leak was subject to error (there was no true “gold standard”).
• The studies included few participants, leading to uncertainty in the results.
• The studies were poorly performed, adding more uncertainty.

The authors concluded that well-designed studies with pre-specified index test threshold of drain fluid amylase (at 3 times more on postoperative day 5), appropriate follow-up (for at least 6 weeks to ensure that there are no pancreatic leaks), and clearly defined reference standards are needed.