Acute Pancreatitis After Gastrointestinal Endoscopy

Abstract

Acute pancreatitis is a well-recognized complication of endoscopic retrograde cholangiopancreatography but is not considered to be a complication associated with other endoscopic procedures. We present a case of acute pancreatitis that occurred after uneventful upper and lower gastrointestinal endoscopy. The temporal relationship of the endoscopic procedures and development of acute pancreatitis suggests a causal relation. Furthermore, the patient had none of the usual etiologic factors associated with pancreatitis, i.e., alcoholism, cholelithiasis, hypertriglyceridemia, hypercalcemia, or use of a drug associated with pancreatitis. The causal mechanism of acute pancreatitis is uncertain but might potentially involve local trauma to the pancreas during a procedure or release of as yet undefined inflammatory mediators. In summary, three previous reports of clinical pancreatitis associated with endoscopy, in addition to the current case, suggests that acute pancreatitis should be considered as a rare complication of routine upper endoscopy or colonoscopy.

Post-procedure Elevated Amylase and Lipase Levels After Double-Balloon Enteroscopy: Relations with the Double-Balloon Technique

“…The causal mechanism of acute pancreatitis is uncertain, but might potentially involve local trauma to the pancreas during the procedure or the release of as yet undefined inflammatory mediators that are secreted in response to the mechanical stress. There are rare published cases with acute pancreatitis even after upper and lower gastrointestinal endoscopy, and the authors suggested that mechanical stress might have caused acute pancreatitis [16][17][18][19]. In accordance with these reports, in our study, the findings suggest that the pancreas might be subject to severe mechanical stress by the enteroscope itself and by the inflated overtube balloon, particularly during the first advancement of the instrument.…”

Postcolonoscopy pancreatitis

“…The third case [3] was an uncomplicated procedure. Another case of pancreatitis was reported after combined upper and lower gastrointestinal endoscopies, which were uncomplicated procedures [7]. We agree with the authors of the other case reports [3, 5 -7], who propose that mechanical injury to the body and tail of pancreas by the colonoscope is the likely root cause.…”

Acute pancreatitis following oesophagogastroduodenoscopy.

“…The case reported by Nevins and Keeffe involved an upper and lower endoscopy performed for evaluation of anaemia in a 69-year-old man with history of hypertension, gastro-oesophageal reflux disease and prior episode of diverticulosis 23. Upper endoscopy was unremarkable and was completed without need for biopsy or cannulation of the ampulla of Vater.…”