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Low incidence of hyperamylasemia after proximal double-balloon enteroscopy: has the insertion technique improved?
H Aktas1, P B F Mensink, J Haringsma
1Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam,The Netherlands.
Background And Study Aim:
Reported complications of double-balloon enteroscopy (DBE) include post-enteroscopy pancreatitis. Hyperamylasemia after proximal DBE is reported frequently, but the relationship to development of pancreatitis remains unclear. Hyperamylasemia may be related to balloon inflation in the pancreatic head region. The aims of the study were to identify risk factors for hyperamylasemia and to determine the incidence of hyperamylasemia and pancreatitis when a modified cautious DBE insertion protocol was used.
Patients And Methods:
In a prospective study, involving consecutive patients undergoing a proximal DBE, serum amylase activity was assessed immediately before and after the procedure.
Results:
135 patients were included (men 78, women 57; mean age 49 years [range 17 - 88]). The mean total procedure time was 73 minutes (range 30 - 150 minutes), and mean number of passes during the proximal DBE was 14 (6 - 24). While patients (17 %) developed hyperamylasemia after the DBE procedure, only one patient with hyperamylasemia had clinical symptoms indicating a mild acute pancreatitis (0.7 %). Total procedure time and number of passes correlated significantly with the occurrence of hyperamylasemia.
Conclusions:
We found a low incidence of hyperamylasemia and pancreatitis post-DBE. Theoretically, this could result from the modified insertion technique, with local strain and friction of the small bowel as remaining causes of hyperamylasemia, a notion supported by the significant relation between hyperamylasemia and duration of DBE and total number of passes. We therefore advise use of the cautious insertion technique and, if possible, reduction of duration and of number of passes in every proximal DBE.
Insights
Double-balloon enteroscopy (DBE) can cause hyperamylasemia, but a modified cautious technique shows a low incidence of pancreatitis. Procedure duration and passes correlate with hyperamylasemia, suggesting technique modifications to minimize risk.
Area of Science:
- Gastroenterology
- Endoscopy
- Pancreatology
Background:
- Complications of double-balloon enteroscopy (DBE) include post-enteroscopy pancreatitis.
- Hyperamylasemia is frequently observed after proximal DBE, but its link to pancreatitis is unclear.
- Hyperamylasemia may stem from balloon inflation near the pancreatic head.
Purpose of the Study:
- Identify risk factors for hyperamylasemia following proximal DBE.
- Determine the incidence of hyperamylasemia and pancreatitis using a modified cautious DBE insertion protocol.
Main Methods:
- Prospective study of consecutive patients undergoing proximal DBE.
- Serum amylase activity measured immediately before and after the procedure.
- Analysis of risk factors including procedure time and number of passes.
Main Results:
- 135 patients included; 17% developed hyperamylasemia post-DBE.
- Only one patient (0.7%) experienced mild acute pancreatitis.
- Total procedure time and number of passes significantly correlated with hyperamylasemia.
Conclusions:
- A modified cautious DBE insertion technique resulted in low incidence of hyperamylasemia and pancreatitis.
- Hyperamylasemia is linked to procedure duration and number of passes, possibly due to local strain.
- Advise cautious insertion, reduced duration, and fewer passes for proximal DBE to minimize risks.
