Risk Factors of Acute Pancreatitis in Oral Double Balloon Enteroscopy

Abstract

Summary: Double balloon enteroscopy (DBE) was introduced 15 years ago. The complications of diagnostic DBE are rare, acute pancreatitis is most redoubtable one (incidence about 0.3%). Hyperamylasemia after DBE seems to be a rather common condition respectively. The most probable cause seems to be a mechanical straining of the pancreas. We tried to identify patients in a higher risk of acute pancreatitis after DBE. We investigated several laboratory markers before and after DBE (serum cathepsin B, lactoferrin, E-selectin, SPINK 1, procalcitonin, S100 proteins, alfa-1-antitrypsin, hs-CRP, malondialdehyde, serum and urine amylase and serum lipase). Serum amylase and lipase rose significantly with the maximum 4 hours after DBE. Serum cathepsin and procalcitonin decreased significantly 4 hours after DBE compared to healthy controls and patients values before DBE. Either serum amylase or lipase 4 hours after DBE did not correlate with any markers before DBE. There was a trend for an association between the number of push-and-pull cycles and procalcitonin and urine amylase 4 hours after DBE; between procalcitonin and alfa-1-antitrypsin, cathepsin and hs-CRP; and between E-selectin and malondialdehyde 4 hours after DBE. We found no laboratory markers determinative in advance those patients in a higher risk of acute pancreatitis after DBE.

Evidences supporting the vascular etiology of post-double balloon enteroscopy pancreatitis: Study in porcine model

“…In addition to reviewing the etiologies of the post-DBE pancreatitis, a discussion about potential risks involved in this complication is pertinent. The time length of the procedure, the final depth of endoscope insertion and the purpose of the DBE (diagnostic vs therapeutic) have been mentioned[ 14 , 16 , 17 , 20 , 31 , 40 ]. Again, the use of a validated animal model for DBE allows a more accurate approach to this topic[ 32 - 35 ].…”

“…Concerning the post-DBE pancreatitis several case-series published in Europe[ 8 , 9 ], Asia[ 7 , 10 , 11 ] and United States[ 12 ] refer figures as low as 0.3%, and in the opposite, as high as 3%[ 13 - 15 ] or even 12.5%[ 16 ]. Overall, in a recent paper, Kopacova reported a historic accumulation of more than 100 post-DBE pancreatitis already published[ 17 ].…”

“…Patients with subclinical mild acute pancreatitis are usually discharged during the early phase and usually do not require pancreatic imaging, and mortality is very rare. Besides many of mild pancreatitis could be missed in patients with DBE performed on an outpatient basis[ 17 ]. It is unknown how many patients with self-controlled abdominal pain have been able to have mild acute pancreatitis post-DBE[ 17 ].…”

“…Besides many of mild pancreatitis could be missed in patients with DBE performed on an outpatient basis[ 17 ]. It is unknown how many patients with self-controlled abdominal pain have been able to have mild acute pancreatitis post-DBE[ 17 ]. This circumstance of lack of patient follow-up suggests to some authors a generalized underestimation of the number of post-DBE pancreatitis[ 13 ].…”

“…Thus, amylase concentration below the double of the basal levels has been found in 39%[ 15 ], 46%[ 21 ] or even 58%[ 20 ] of oral DBE at 24 h of procedure. Hyperlipasemia has been described from as soon as 4 h[ 16 , 17 , 20 , 22 ], to up 12 h[ 16 ] or 24 h[ 16 , 17 , 20 ] after DBE. Also, in patients where pancreatic disease was diagnosed lipase levels remained increased even after amylase returned to normal figures[ 23 ].…”