Cholecystokinin in the early course of acute post-ERCP pancreatitis.
BACKGROUND
A high dose of cholecystokinin (CCK) agonist cerulein can induce acute pancreatitis in animals. The role of CCK in the induction of acute pancreatitis in humans is unclear. We investigated basal plasma CCK levels before and after induction of post-ERCP pancreatitis to determine CCK levels in the early course of the disease.


METHODS
We determined plasma CCK concentrations in four groups of patients who underwent ERCP: (1) post-ERCP pancreatitis patients (n = 23); (2) patients with post-ERCP hyperamylasemia without pancreatitis (n = 5); (3) patients with post-ERCP abdominal pain without hyperamylasemia (n = 18); and (4) patients with an uneventful post-ERCP period (n = 43). Plasma samples were taken before ERCP, 4 to 8 hours, 10 to 16 hours, and 24 hours after ERCP. Plasma CCK concentrations were determined by a specific and sensitive radioimmunoassay using CCK antiserum (Euro-Diagnostica, Malmö, Sweden).


RESULTS
Plasma CCK levels increased five-fold early in the course in post-ERCP pancreatitis patients, but not in post-ERCP hyperamylasemia patients or in uncomplicated ERCP patients, where CCK levels temporarily decreased after ERCP. In patients with abdominal pain, CCK levels did not change. After the early increase, plasma CCK levels declined to almost unmeasurable levels one day after the onset of symptoms in post-ERCP pancreatitis. In other groups CCK levels were close to the pre-ERCP level.


CONCLUSIONS
It remains to be shown whether CCK is important in the pathogenesis of post-ERCP pancreatitis or merely a secondary phenomenon. There is a rationale to test CCK antagonists in preventing post-ERCP pancreatitis.
Räty
S
S
Department of Surgery, Tampere University Hospital, Finland.
Sand
J
J
Laine
S
S
Harmoinen
A
A
Nordback
I
I
D015746:Abdominal Pain / Q000209:etiology; D000681:Amylases / Q000097:blood; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D002766:Cholecystokinin / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood* / Q000209:etiology; D011446:Prospective Studies; D011863:Radioimmunoassay; D013997:Time Factors
D002766:Cholecystokinin; D000681:Amylases