A

Multiple comparative studies show that serum pancreatic lipase has higher sensitivity, similar or better specificity, and a longer diagnostic window than serum amylase for acute pancreatitis. The pivotal study that asked this exact question found lipase had an AUC of 0.948 versus 0.906 for amylase, with markedly fewer false-negatives; the authors concluded lipase is the more accurate biomarker and, by implication, should replace amylase in routine testing [Smith et al., 2005, PMID 15943725]. Subsequent reviews and prospective cohorts have confirmed that lipase alone provides equal or better diagnostic performance, while ordering both enzymes adds little clinical value and increases costs [Ismail & Bhayana, 2017, PMID 28720341; Treacy et al., 2001, PMID 11552931]. Therefore, the evidence supports substituting serum pancreatic lipase for serum amylase in the diagnosis of acute pancreatitis.