Evaluation of selected parameters of the inflammatory response to endoscopic retrograde cholangiopancreatography.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a well-established method in diagnosis and management of biliary and pancreatic diseases. The procedure carries the risk of serious complications; the most common is pancreatitis. The severity of ERCP-related pancreatitis largely depends on the inflammatory response to the procedure. The aim of our study was to evaluate the inflammatory response after diagnostic and therapeutic ERCP based on monitoring of plasma concentration of the following substances: amylase, lipase, white blood cells, interleukin 6 (IL-6), C-reactive protein (CRP), hydrogen peroxide, malonylodialdehyde (MDA), and conjugated dienes (CD). The study was performed on 40 patients who were divided into two groups according to the procedure performed: Group1-28 patients after ERCP with endoscopic sphincterotomy (ES) and Group 2-12 patients after diagnostic ERCP. The parameters were measured before ERCP and 2, 24, and 48 hours after the procedure. After diagnostic and therapeutic ERCP, the increase in plasma concentration of amylase, lipase, IL-6, and CRP were observed. Acute pancreatitis developed in three of the patients from group 1. The increase in lipase and CRP concentration was significantly higher after therapeutic ERCP with ES than after the diagnostic procedure. Asymptomatic hyperamylasemia and hyperlipasemia occurred more often after therapeutic than diagnostic ERCP. A positive correlation between the increase of IL-6 and CRP concentration was found. After uncomplicated diagnostic or therapeutic ERCP, no increase of reactive oxygen species and lipid peroxidation products was observed. Diagnostic ERCP stimulates a systemic inflammatory response, the intensity of which is magnified after ES. After uncomplicated ERCP, the balance between oxidative and anti-oxidative mechanisms is retained.