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

Abstract

Hyperamylasemia and hyperlipasemia after DBE seems to be a complication of peroral DBE, which might be prevented by reducing the time between the first and second inflations of the overtube balloon.

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

“…This number is within the range of complication currently associated to the therapeutic conventional endoscopy techniques. 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 ].…”

“…Increased levels of one or more of the pancreatic serum markers is very common after oral DBE[ 16 , 20 , 21 ]. 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.…”

“…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 ].…”

“…Also, in patients where pancreatic disease was diagnosed lipase levels remained increased even after amylase returned to normal figures[ 23 ]. The C-reactive protein (CRP) can also be related to either non-specific inflammation of the bowel mucosa or pancreatic inflammation, thus its diagnostic significance very much depends on the concomitant appearance of increased levels of amylase and/or lipase[ 14 , 16 ]. Regarding the evolution of these three serum markers, in a recent study, we determined pre- and post-procedure (4 h) levels of amylase, lipase and CRP in a series of 55 randomly selected patients for oral DBE (non-published data).…”

“…Nevertheless, up to three different hypotheses have been formulated. One refers to a reduced blood perfusion of the pancreas and the bowel (vascular etiology)[ 14 , 24 , 27 ], another to obstruction of the duodenal papilla by mechanical pressure or damage (papilla injury etiology)[ 13 , 15 , 16 , 21 , 25 , 28 - 30 ], and the third one to potential pancreatic reflux due to increased intraluminal pressure within the small bowel (reflux etiology)[ 24 , 31 ]. To better understanding the problem in the last decade we have carried out several of experiments in porcine model[ 32 - 39 ] where oral DBE were systematically monitored.…”