AIM:To investigate the correlations between serum amylase levels,intestinal permeability(IP),and pancreatic injury and to explore the mechanisms responsible for hyperamylasemia in double-balloon enteroscopy(DBE).METHO...AIM:To investigate the correlations between serum amylase levels,intestinal permeability(IP),and pancreatic injury and to explore the mechanisms responsible for hyperamylasemia in double-balloon enteroscopy(DBE).METHODS:A prospective study was conducted in 20patients who underwent DBE from August 1,2008 to February 28,2009.Serum amylase was examined 0,2,6 and 24 h post-DBE,C-reactive protein and lipase were examined at 24 h,and urine lactulose,mannitol,and trypsinogen-Ⅱ(TRY-Ⅱ)levels were measured at6 h.Lactulose/mannitol ratio indicated IP,and TRY-Ⅱindicated pancreatic injuries.Procedure duration and enteroscope insertion length were recorded.RESULTS:Twelve patients underwent oral DBE(M:F,5:7;mean age 50.42±11.11 years)and 8 underwent anal DBE(M:F,5:3;mean age 44.75±12.66 years).They all showed significantly increased post-DBE serum amylase.Amylase and lipase levels were higher in the oral DBE group(P<0.05).Hyperamylasemia was diagnosed in 9(75.0%)patients undergoing oral DBE.Only patients receiving oral DBE showed increased postprocedure IP,which correlated with increased serum amylase(r=0.611,P=0.035)and procedure duration(r=0.668,P=0.018).Adverse events included one oral case with pancreatic injury(elevated TRY-Ⅱ)and two cases of abdominal discomfort in each group.Pancreatitis was not reported.CONCLUSION:Hyperamylasemia correlates with increased IP and clinically undetectable pancreatic injuries.DBE could cause intestinal mucosa damage,which may result in IP elevation and increased amylase absorption,necessitating improvements and standardization of DBE methods.展开更多
AIM:To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography(PEP).METHODS:One hundred and seventy patients were enrolled and randomized to ...AIM:To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography(PEP).METHODS:One hundred and seventy patients were enrolled and randomized to two groups:a study group(n=85)who received 300 mg of oral allopurinol at 15 h and 3 h before endoscopic retrograde cholangiopancreatography(ERCP)and a control group(n=85)receiving an oral placebo at the same times.Main Outcome Measurements included serum amylase levels and the number severity of the episodes of pancreatitis.Serum amylase levels were classified as normal(<150 IU/L)or hyperamylasemia(>151 IU/L).Episodes of PEP were classified following Ranson's criteria and CT severity index.RESULTS:Gender distribution was similar between groups.Mean age was 53.5±18.9 years for study group and 52.8±19.8 years for controls.Also,the distribution of benign pathology was similar between groups.Hyperamylasemia was more common in the control group(P=0.003).Mild PEP developed in two patients from the study group(2.3%)and eight(9.4%) from control group(P=0.04),seven episodes were observed in high-risk patients of the control group(25%) and one in the allopurinol group(3.3%,P=0.02).Risk factors for PEP were precut sphincterotomy(P=0.02),pancreatic duct manipulation(P=0.002)and multiple procedures(P=0.000).There were no deaths or side effects.CONCLUSION:Oral allopurinol before ERCP decreased the incidences of hyperamylasemia and pancreatitis in patients submitted to high-risk procedures.展开更多
Background Effects of prophylactic somatostatin on post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP） and hyperamylasemia remain inconclusive. This study aimed to examine whether high-do...Background Effects of prophylactic somatostatin on post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP） and hyperamylasemia remain inconclusive. This study aimed to examine whether high-dose, long-term continuous infusion of somatostatin can reduce the incidence of PEP and post-ERCP hyperamylasemia. Methods This was a randomized, placebo-controlled pilot trial. One hundred and twenty-four patients scheduled for ERCP from December 2008 to May 2010 randomly received one of the following three interventions： pre-ERCP somatostatin （0.5 mg/h for 24 hours, starting 1 hour prior to ERCP; n=36）, post-ERCP somatostatin （0.5 mg/h for 24 hours, starting 1 hour after ERCP; n=47）, or placebo （saline for 24 hours, starting 1 hour prior to ERCP; n=41）. Serum amylase and lipase concentrations were measured 1 to 3 hours prior to ERCP and 6, 24, and 48 hours after ERCP. Results The three groups did not differ in age, gender, medical history, or ERCP procedure （catheterization using contrast or guidewire, pancreatic duct visualization, procedure time, or procedure type）. The rate of PEP was 13.7% （17/124） in the overall study sample and 16.7% （6/36）, 10.6% （5/47）, and 14.6% （6/41） in the pre-ERCP somatostatin, post- ERCP somatostatin, and placebo groups, respectively （P=0.715）. The rate of post-ERCP hyperamylasemia was 19.4% （7/36）, 21.3% （10/47）, and 46.3% （19/41） in the pre-ERCP somatostatin, post-ERCP somatostatin, and placebo groups, respectively （P=0.011）. Conclusions High-dose, long-term continuous infusion （0.5 mg/h for 24 hours） of somatostatin, performed as either a pre- or post-ERCP, can reduce the incidence of hyperamylasemia, but not PEP.展开更多
文摘AIM:To investigate the correlations between serum amylase levels,intestinal permeability(IP),and pancreatic injury and to explore the mechanisms responsible for hyperamylasemia in double-balloon enteroscopy(DBE).METHODS:A prospective study was conducted in 20patients who underwent DBE from August 1,2008 to February 28,2009.Serum amylase was examined 0,2,6 and 24 h post-DBE,C-reactive protein and lipase were examined at 24 h,and urine lactulose,mannitol,and trypsinogen-Ⅱ(TRY-Ⅱ)levels were measured at6 h.Lactulose/mannitol ratio indicated IP,and TRY-Ⅱindicated pancreatic injuries.Procedure duration and enteroscope insertion length were recorded.RESULTS:Twelve patients underwent oral DBE(M:F,5:7;mean age 50.42±11.11 years)and 8 underwent anal DBE(M:F,5:3;mean age 44.75±12.66 years).They all showed significantly increased post-DBE serum amylase.Amylase and lipase levels were higher in the oral DBE group(P<0.05).Hyperamylasemia was diagnosed in 9(75.0%)patients undergoing oral DBE.Only patients receiving oral DBE showed increased postprocedure IP,which correlated with increased serum amylase(r=0.611,P=0.035)and procedure duration(r=0.668,P=0.018).Adverse events included one oral case with pancreatic injury(elevated TRY-Ⅱ)and two cases of abdominal discomfort in each group.Pancreatitis was not reported.CONCLUSION:Hyperamylasemia correlates with increased IP and clinically undetectable pancreatic injuries.DBE could cause intestinal mucosa damage,which may result in IP elevation and increased amylase absorption,necessitating improvements and standardization of DBE methods.
基金Supported by Economic resources of the Department of Gastroenterology and Endoscopythe Research Unit in Clinical Epidemiology
文摘AIM:To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography(PEP).METHODS:One hundred and seventy patients were enrolled and randomized to two groups:a study group(n=85)who received 300 mg of oral allopurinol at 15 h and 3 h before endoscopic retrograde cholangiopancreatography(ERCP)and a control group(n=85)receiving an oral placebo at the same times.Main Outcome Measurements included serum amylase levels and the number severity of the episodes of pancreatitis.Serum amylase levels were classified as normal(<150 IU/L)or hyperamylasemia(>151 IU/L).Episodes of PEP were classified following Ranson's criteria and CT severity index.RESULTS:Gender distribution was similar between groups.Mean age was 53.5±18.9 years for study group and 52.8±19.8 years for controls.Also,the distribution of benign pathology was similar between groups.Hyperamylasemia was more common in the control group(P=0.003).Mild PEP developed in two patients from the study group(2.3%)and eight(9.4%) from control group(P=0.04),seven episodes were observed in high-risk patients of the control group(25%) and one in the allopurinol group(3.3%,P=0.02).Risk factors for PEP were precut sphincterotomy(P=0.02),pancreatic duct manipulation(P=0.002)and multiple procedures(P=0.000).There were no deaths or side effects.CONCLUSION:Oral allopurinol before ERCP decreased the incidences of hyperamylasemia and pancreatitis in patients submitted to high-risk procedures.
文摘Background Effects of prophylactic somatostatin on post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP） and hyperamylasemia remain inconclusive. This study aimed to examine whether high-dose, long-term continuous infusion of somatostatin can reduce the incidence of PEP and post-ERCP hyperamylasemia. Methods This was a randomized, placebo-controlled pilot trial. One hundred and twenty-four patients scheduled for ERCP from December 2008 to May 2010 randomly received one of the following three interventions： pre-ERCP somatostatin （0.5 mg/h for 24 hours, starting 1 hour prior to ERCP; n=36）, post-ERCP somatostatin （0.5 mg/h for 24 hours, starting 1 hour after ERCP; n=47）, or placebo （saline for 24 hours, starting 1 hour prior to ERCP; n=41）. Serum amylase and lipase concentrations were measured 1 to 3 hours prior to ERCP and 6, 24, and 48 hours after ERCP. Results The three groups did not differ in age, gender, medical history, or ERCP procedure （catheterization using contrast or guidewire, pancreatic duct visualization, procedure time, or procedure type）. The rate of PEP was 13.7% （17/124） in the overall study sample and 16.7% （6/36）, 10.6% （5/47）, and 14.6% （6/41） in the pre-ERCP somatostatin, post- ERCP somatostatin, and placebo groups, respectively （P=0.715）. The rate of post-ERCP hyperamylasemia was 19.4% （7/36）, 21.3% （10/47）, and 46.3% （19/41） in the pre-ERCP somatostatin, post-ERCP somatostatin, and placebo groups, respectively （P=0.011）. Conclusions High-dose, long-term continuous infusion （0.5 mg/h for 24 hours） of somatostatin, performed as either a pre- or post-ERCP, can reduce the incidence of hyperamylasemia, but not PEP.
