Post-procedure elevated amylase and lipase levels after double-balloon enteroscopy: relations with the double-balloon technique.

BACKGROUND: Small elevations of pancreatic enzymes are recently recognized complications of double-balloon enteroscopy (DBE).

AIMS: The aim of this study was to check the post-procedure pancreatic enzyme (p-amylase, lipase) levels and to disclose their relationships with technical features of DBE.

METHODS: Peroral (48) and peranal (8) DBEs were performed in 56 patients, and the p-amylase and lipase levels were measured just before and after the procedure. Patients were also evaluated for abdominal pain after DBE using a visual analog scale (VAS). The route-total duration of the procedure, the total insertion length of the scope, the insertion length where the overtube balloon was inflated for the first time, and the duration between the first and second inflations were also noted.

RESULTS: Pancreatitis was observed in 6 of 48 (12.5%) peroral DBE patients. A VAS score above 5 at 4 h had a sensitivity of 100% and specificity of 96% for developing post-DBE pancreatitis. Significant correlations were noted between the levels of pancreatic enzymes after DBE and the total insertion length, duration, and duration between the first and second inflations of the balloon, and an inverse correlation was observed between the levels of these enzymes and insertion length at the first inflation, but an age-sex-adjusted regression analysis only disclosed the duration between the first and second inflations as an independent predictor of post-DBE pancreatitis (P = 0.012).

CONCLUSIONS: Hyperamylasemia and hyperlipasemia after DBE seems to be a complication of peroral DBE, which might be prevented by reducing the time between the first and second inflations of the overtube balloon.