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

Abstract

Background and aims: Although the safety of double balloon enteroscopy (DBE) was emphasized in large series of patients, post-procedure cases of acute pancreatitis and merely elevations of pancreatic enzymes recently have been reported. The aim of this prospective study was to check the pre- and post-procedure pancreatic-amylase and lipase levels and to disclose their relationships with technical features of DBE. Material and methods: Peroral(48) and anal(8) DBEs were performed in 56 patients. Blood samples were taken before, four, 12 h. after the procedure and patients were evaluated for abdominal pain after four hours using visual analogue scale(VAS). The route and duration of DBE, the total insertion lenght of the scope, the insertion lenght where firstly the balloon was inflated and the duration between the first and second balloon inflations were noted. Hyperamylasemia was defined as an elevation of pancreatic amylase to more than the upper normal limit (>65 IU/ml) and pancreatitis was diagnosed when amylase levels reached at least three times the upper normal limit (>200 IU/ml) in the presence of pancretic-type abdominal pain. Results: All the patients had normal amylase and lipase levels before the procedure. None of the eight patients undergoing anal DBE disclosed pancreatic enzyme elevations whereas the mean ± SD amylase levels of patients in peroral DBE group at 4 hours after the procedure was significantly higher when compared to the amylase levels at the beginning and 12 hours after the procedure (53.62 ± 18,2 IU/ml, 272.00 ± 351.52 IU/ml, 116.14 ± 96.62 IU/ml for 0. h, 4 h, 12 h, respectively ; p = 0.001).Hyperamylasemia and hyperlipasemia four hours after peroral DBE occured in 12 patients (25%) six of them (12.5%) developing pancreatic-type abdominal pain. A VAS score above five at four hours had a sensitivity of 100% and specifity of 96% for developing post-DBE pancreatitis. Significant correlations were noted between elevation of pancreatic amylase and total insertion lenght (r = 0.46, p = 0.01), insertion lenght during the first inflation of balloon (r= -0.43, p = 0.02), and duration between the first and second inflations (r = 0.87, p = 0.001). Multivariant regression analysis, disclosed the duration between the first and second inflations of the balloon as the only independent predictor of post-DBE pancreatitis (R2= 0.528, p= 0.000). Conclusions: Despite the relative small sample size, elevation of pancreatic enzymes and pancreatitis seem to be a common complication of peroral DBE, which might be prevented by deeper insertion of the scope before the first inflation of the balloon and by reducing the time between the first and second inflations.