The effect of ERCP on circulating pancreatic enzymes and pancreatic protease inhibitors.
The pathogenesis of endoscopic retrograde cholangiopancreatography (ERCP)-induced pancreatitis is poorly understood. To elucidate a role for pancreatic enzymes in ERCP-induced pancreatitis, we measured serum amylase, lipase, trypsin, and elastase in 25 patients undergoing ERCP. Serum alpha 1-antitrypsin and alpha 2-macroglobulin, two major pancreatic protease inhibitors, also were measured. All pancreatic enzymes measured rose significantly after ERCP. Pancreatic duct cannulation was associated with a greater elevation in serum amylase and lipase. Circulating alpha 2-macroglobulin was reduced by 7% (p = 0.04) 6 h after ERCP, whereas circulating alpha 1-antitrypsin increased over the same time period. Papillotomy, stent placement, or underlying disease did not influence changes any further. Three patients developed ERCP-induced pancreatitis. All three patients had circulating alpha 2-macroglobulin levels below 243 mg/dl (p = 0.03). The ERCP-induced alterations in circulating pancreatic enzymes and their inhibitors are similar to changes seen in clinical pancreatitis. Low circulating alpha 2-macroglobulin levels may predispose to ERCP-induced pancreatitis.
Conn
M
M
Department of Medicine (Division of Gastroenterology), Mount Sinai School of Medicine of the City University of New York, NY.
Goldenberg
A
A
Concepcion
L
L
Mandeli
J
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000510:Alpha-Globulins / Q000032:analysis*; D000681:Amylases / Q000097:blood; D000704:Analysis of Variance; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006867:Hydrolases / Q000097:blood*; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000201:enzymology*; D010196:Pancreatic Elastase / Q000097:blood; D010195:Pancreatitis / Q000201:enzymology* / Q000209:etiology*; D014357:Trypsin / Q000097:blood; D000515:alpha 1-Antitrypsin / Q000032:analysis; D000511:alpha-Macroglobulins / Q000032:analysis
D000510:Alpha-Globulins; D000515:alpha 1-Antitrypsin; D000511:alpha-Macroglobulins; D006867:Hydrolases; D008049:Lipase; D000681:Amylases; D010196:Pancreatic Elastase; D014357:Trypsin