Acute Pancreatitis: An Unusual Complication of Double Balloon Enteroscopy

Abstract

Purpose: 76 year old male with critical aortic stenosis presented for evaluation of transfusion-requiring iron deficiency anemia. As esophagoduodenoscopy, colonoscopy, capsule endoscopy, and CT enterography were unremarkable, a double-balloon enteroscopy (DBE) was performed and revealed a moderate sized jejunal vascular ectasia that was treated with argon plasma coagulation. There were no immediate procedure-related complications.FigureApproximately 4 hours later he presented with severe abdominal pain. Significant laboratories included a markedly elevated lipase (924 U/L [10–73 U/L]) and amylase (380 U/L [26–102 U/L]). CT abdomen revealed inflammatory changes in the body and tail of the pancreas and significant edema in the peripancreatic fat (Fig. 1) but there was no evidence of necrosis. He improved gradually over the course of the next week with conservative treatment. CT abdomen 2 months (Fig. 2) later demonstrated persistent inflammatory changes in the pancreatic body and tail and ill-defined fluid collections in and around the pancreatic tail. However, the patient was asymptomatic. Repeat CT 6 weeks later noted decrease in size of the fluid collections and pancreatic inflammation. He had an uneventful aortic valve replacement at this point. CT performed 4 months later demonstrated a normally enhancing pancreas with minimal residual fluid collection. Our report adds to previous case reports from Japan and Netherlands of this uncommon complication of DBE. Though there are no prospective series, the estimated prevalence of pancreatitis following DBE is around 1%. The etiology of pancreatitis following DBE is unclear but may be related to duodenal reflux or transient sphincter of Oddi dysfunction, which may occur during a long procedure such as DBE with compression of the ampulla. Prospective evaluation of the complications of DBE is needed.[figure1][figure2]Figure