RSS-Feed abonnieren
DOI: 10.1055/s-0029-1214976
© Georg Thieme Verlag KG Stuttgart · New York
Low incidence of hyperamylasemia after proximal double-balloon enteroscopy: has the insertion technique improved?
Publikationsverlauf
submitted4 March 2009
accepted after revision28 May 2009
Publikationsdatum:
10. August 2009 (online)
![](https://www.thieme-connect.de/media/endoscopy/200908/lookinside/thumbnails/10.1055-s-0029-1214976-1.jpg)
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.
References
- 1 Yamamoto H, Yano T, Kita H. et al . New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal disorders. Gastroenterology. 2003; 125 1556-1557
- 2 Yamamoto H, Sugano K. A new method of enteroscopy: the double-balloon method. Can J Gastroenterol. 2003; 17 273-274
- 3 Yamamoto H, Sekine Y, Sato Y. et al . Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001; 53 216-220
- 4 May A, Nachbar L, Ell C. Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease. Gastrointest Endosc. 2005; 62 62-70
- 5 Mensink P B, Haringsma J, Kucharzik T. et al . Complications of double balloon enteroscopy: a multicenter survey. Endoscopy. 2007; 39 613-615
- 6 Möschler O, May A D, Müller M K. et al . Complications in double-balloon-enteroscopy: results of the German DBE register. Z Gastroenterol. 2008; 46 266-270 [in German]
- 7 Groenen M J, Moreels T G, Orlent H. et al . Acute pancreatitis after double-balloon enteroscopy: an old pathogenetic theory revisited as a result of using a new endoscopic tool. Endoscopy. 2006; 38 82-85
- 8 Heine G D, Hadithi M, Groenen M J. et al . Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy. 2006; 38 42-48
- 9 Honda K, Itaba S, Mizutani T. et al . An increase in the serum amylase level in patients after peroral double-balloon enteroscopy: an association with the development of pancreatitis. Endoscopy. 2006; 38 1040-1043
- 10 Kopacova M, Rejchrt S ;. et al . Hyperamylasemia of uncertain significance associated with oral double-balloon enteroscopy. Gastrointest Endosc. 2007; 66 1133-1138
- 11 Barkin J S, Lewis B S, Reiner D K. et al . Diagnostic and therapeutic jejunoscopy with a new, longer enteroscope. Gastrointest Endosc. 1992; 38 55-58
- 12 Taylor A C, Buttigieg R J, McDonald I G, Desmond P V. Prospective assessment of the diagnostic and therapeutic impact of small-bowel push enteroscopy. Endoscopy. 2003; 35 951-956
- 13 Honda K, Mizutani T, Nakamura K. et al . Acute pancreatitis associated with peroral double-balloon enteroscopy: a case report. World J Gastroenterol. 2006; 12 1802-1804
- 14 Pohl J, Blancas J M, Cave D. et al . Consensus report of the 2nd International Conference on Double-Balloon Endoscopy. Endoscopy. 2008; 40 156-160
- 15 Banks P, Freeman M. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006; 101 2379-2400
P. B. F. MensinkMD, PhD
Erasmus MC-University Medical Center
Department of Gastroenterology and Hepatology
’s Gravendijkwal 230
3015 CE Rotterdam
The Netherlands
Fax: +31-10-7034682
eMail: p.mensink@erasmusmc.nl