Hyperamylasaemia after duodenoscopy and retrograde cholangiopancreatography.

Abstract

SUMMARY The salivary and pancreatic isoamylases of serum were determined separately in 234 cases ofduodenoscopy and retrograde cholangiopancreatography. Successful pancreatic opacification was associated with pathologically high pancreatic serum amylase activities in 60% of the cases.Extensive opacification was associated with large increases of pancreatic serum isoamylases, the maximal rise recorded was 40 times the initial value. In spite of these striking chemical events only two patients developed clinical acute pancreatitis. There were some variations in pancreatic opacification and in the elevation of pancreatic serum amylase which seemed to depend upon the particular contrast material used. A rise of the salivary serum isoamylases caused pathologically high total serum amylase activities in 7% of the cases. High levels of pancreatic serum isoamylase activity before the time of examination did not result in any different pattern of hyperamylasaemia.

Pancreatits after endoscopic retrograde cholangio-pancreatography

“…Quantitation of the volume injected appears to be of limited clinical value, as contrast tends to spill into the duodenum. However, the greatest elevations of total serum amylase activity and the highest frequencies of elevation occurred after complete filling of the acini [57,58] . Skude et al [57] in a series of 219 patients reported that pancreatic enzyme level elevation after ERCP correlated directly with the extent of opacification of the pancreatic duct system.…”

“…However, the greatest elevations of total serum amylase activity and the highest frequencies of elevation occurred after complete filling of the acini [57,58] . Skude et al [57] in a series of 219 patients reported that pancreatic enzyme level elevation after ERCP correlated directly with the extent of opacification of the pancreatic duct system. Increases in intraductal pressure and filling of side branches may result in leakage of the pancreatic secretions into the circulation.…”

Serial Changes in Serum Levels of Pancreatic Isoamylase, Trypsin and Elastase 1 after Surgical Interventions to the Pancreas

“…It is difficult to determine the exact time of the onset when the inflammation of the pan creas occurs. Serum levels of pancreatic enzymes repre sent rapid elevation after endoscopic retrograde pancrea tography [9][10][11] because this phenomenon is caused by a transient passage of pancreatic fluid into the bloodstream through the acinovenous pathway following a rapid and marked elevation of intraductal pancreatic pressure [10,12]. Therefore, no previous studies have demonstrated the alterations of serum levels of pancreatic enzymes dur ing the period from the beginning of increase in serum levels to the maximal levels.…”

Iopentol (Imagopaque® 250) compared with diatrizoate (Urografin® 219) in endoscopic retrograde cholangio-pancreatography (ERCP) A clinical trial assessing safety (adverse events and S-pancreatic iso-amylase) and diagnostic information (VAS)

“…ERCP causes hyperamylasemia in 20-70 % of examinations. Post-ERCP pancreatitis occurs in 1-7 % of patients, and is associated with increased morbidity and, occasionally, mortality [1][2][3][4]. Almost certainly, the aetiology of this type of pancreatitis is multifactorial.…”