title: Evaluation of ERCP- and endoscopic sphincterotomy-induced pancreatic damage: a prospective study on the time course and the significance of serum levels of pancreatic secretory enzymes.
abstract: In the present study the time courses of serum lipase, serum amylase and serum elastase 1 after ERCP/ES as indicators for pancreatic damage were prospectively analysed in 46 cases. The elevations of pancreatic enzymes after ERCP/ES scattered in a wide range and elevations occured which were greater than one hundred times the upper limit of normal. A moderate increment was seen as early as 5 minutes after intubation of the papilla. Elevations above the upper limit of normal were still seen at 24 hours after the procedure. The maxima occurred about 6 hours after the procedure. Lipase was the most sensitive among the parameters tested, nearly 50% of the cases with previously normal values revealed elevated lipase after the procedure. For daily clinical routine a single lipase measurement at 2 hours after the beginning of the ERCP/ES provides valuable information for planning further surveillance. Younger age and high calcium levels seem to be risk factors for ERCP/ES-induced pancreatic damage. The time course of serum lipase seems to be a more reliable criterion for ERCP/ES-induced pancreatic damage than the poorly defined complication of post-ERCP pancreatitis . The high incidence of a measurable pancreatic injury after ERCP/ES provides a sensitive tool for the testing of drugs claimed to be protective for the pancreas and for evaluating new ERCP/ES techniques. Measurement of the serum lipase before, 8 and 24 hours after the procedure, and a detailed description of degree and duration of pain, are necessary for such studies.
authors.affiliation: 3rd Department of Medicine, Justus Liebig University, Rodthohl 6, Giessen D-35385, Germany.
authors.forename: W E
authors.initials: WE
authors.lastname: Doppl
authors.forename: H P
authors.initials: HP
authors.lastname: Weber
authors.forename: H
authors.initials: H
authors.lastname: Temme
authors.forename: H U
authors.initials: HU
authors.lastname: Klör
authors.forename: K
authors.initials: K
authors.lastname: Federlin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004796:Clinical Enzyme Tests / Q000379:methods; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010146:Pain; D010179:Pancreas / Q000473:pathology*; D010182:Pancreatic Diseases / Q000097:blood / Q000201:enzymology / Q000209:etiology*; D010196:Pancreatic Elastase / Q000097:blood; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D009803:Sphincter of Oddi / Q000601:surgery
chemical_list: D008049:Lipase; D000681:Amylases; D010196:Pancreatic Elastase