Acute Pancreatitis after Double-Balloon Enteroscopy: An Old Pathogenetic Theory Revisited as a Result of Using a New Endoscopic Tool

Double-balloon enteroscopy is a novel technique for visualizing the entire small bowel. Complications have been reported relatively rarely in the small series published up until now. In this report we describe two patients who developed acute pancreatitis immediately after double-balloon enteroscopy, diagnosed on clinical, biochemical, and radiological grounds. In both patients the pancreatitis resolved with supportive care. Based on early studies on the pathogenesis of acute pancreatitis, we discuss the possible pathogenetic mechanism for pancreatitis arising as a complication of this novel endoscopic technique.

References

• 1 Yamamoto H, Sekine Y, Sato Y. et al . Total enteroscopy with a nonsurgical steerable double-balloon method.  Gastrointest Endosc. 2001;  53 216-220
• 2 May A, Nachbar L, Wardak A. et al . Double-balloon enteroscopy: preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain.  Endoscopy. 2003;  35 985-991
• 3 Levy M J, Geenen J E. Idiopathic acute recurrent pancreatitis.  Am J Gastroenterol. 2001;  96 2540-2555
• 4 van Brummelen S E, Venneman N G, van Erpecum K J, van Berge-Henegouwen G P. Acute idiopathic pancreatitis: does it really exist or is it a myth?.  Scand J Gastroenterol Suppl. 2003;  239 117-122
• 5 Yamamoto H, Kita H. Enteroscopy.  J Gastroenterol. 2005;  40 555-562
• 6 Ell C, May A, Nachbar L. et al . Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study.  Endoscopy. 2005;  37 613-616
• 7 McCutcheon A D. A fresh approach to the pathogenesis of pancreatitis.  Gut. 1968;  9 296-310
• 8 Pfeffer R B, Stasior O, Hinton J W. The clinical picture of the sequential development of acute hemorrhagic pancreatitis in the dog.  Surg Forum. 1957;  8 248-251
• 9 Creutzfeldt W, Schmidt H. Aetiology and pathogenesis of pancreatitis.  (Current concepts.) Scand J Gastroenterol Suppl. 1970;  6 47-62
• 10 Kaya E, Senyurek G, Dervisoglu A. et al . Acute pancreatitis caused by afferent loop herniation after Billroth II gastrectomy: report of a case and review of the literature.  Hepatogastroenterology. 2004;  51 606-608
• 11 Owyang C, Dozois R R, DiMagno E P, Go V L. Relationships between fasting and postprandial pancreaticoduodenal pressures, pancreatic secretion, and duodenal volume flow in the dog.  Gastroenterology. 1977;  73 1046-1049
• 12 Hendricks J C, DiMagno E P, Go V L, Dozois R R. Reflux of duodenal contents into the pancreatic duct of dogs.  J Lab Clin Med. 1980;  96 912-921
• 13 Rosato E F, Cowan R P, Rosato F E. Duodenal pressure as a factor in the cause of pancreatitis.  Surgery. 1970;  68 837-841
• 14 Ogawa K, Kanemoto K, Shirasaka Y. et al . Acute pancreatic damage associated with convulsive status epilepticus: a report of three cases.  Psychiatry Clin Neurosci. 2001;  55 619-622
• 15 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
• 16 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
• 17 Dreiling D A, Greenstein R J. The sphincter of Oddi, sphincterotomy and biliopancreatic disease.  Am J Gastroenterol. 1979;  72 665-670