title: Risk of hyperamylasemia and acute pancreatitis after double-balloon enteroscopy: a prospective study.
abstract: OBJECTIVE
  There have been reports, mainly retrospective, of pancreatitis and hyperamylasemia after anterograde double-balloon enteroscopy (DBE). Our aim was to report the incidence of pancreatitis and hyperamylasemia after DBE and investigate possible risk factors associated with its occurrence.
  
  
  METHODS
  In this single-center prospective cohort study, serum samples were taken for amylase and lipase before and 3 hours after anterograde DBE in consecutive patients. Multiple variables were recorded, including total procedure time, insertion depth, and number of passes. Patients were evaluated to 24 hours later for signs of pancreatitis. The main outcome measures were the occurrence of hyperamylasemia and pancreatitis.
  
  
  RESULTS
  92 patients were included in the analysis (58 women, 34 men; mean age 54 years, range 18-89). The mean total procedure time was 62 minutes (range 30-120). The mean post-procedure amylase and lipase levels were significantly higher in comparison with the baseline levels (165 U/L vs. 69 U/L and 144 U/L vs. 28 U/L respectively, P<.05); 36 patients (39%) showed hyperamylasemia after the procedure and three patients developed acute mild pancreatitis. Hyperamylasemia was associated more frequently with procedure duration greater than 60 minutes ( P<.001) and insertion depth greater than 25 cm ( P<.013).
  
  
  CONCLUSIONS
  The incidence of hyperamylasemia after anterograde DBE is common and particularly associated with longer procedure time and insertion depth. The cumulative incidence of pancreatitis was 3%. We recommend the avoidance of both unnecessarily lengthy procedures and deep insertion distances in patients who undergo anterograde DBE.
authors.affiliation: Department of Gastrointestinal Endoscopy, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, Mexico City, Mexico. sergiozepeda@medscape.com
authors.forename: S
authors.initials: S
authors.lastname: Zepeda-Gómez
authors.forename: R
authors.initials: R
authors.lastname: Barreto-Zuñiga
authors.forename: S
authors.initials: S
authors.lastname: Ponce-de-León
authors.forename: A
authors.initials: A
authors.lastname: Meixueiro-Daza
authors.forename: J A
authors.initials: JA
authors.lastname: Herrera-López
authors.forename: J
authors.initials: J
authors.lastname: Camacho
authors.forename: F
authors.initials: F
authors.lastname: Tellez-Avila
authors.forename: F
authors.initials: F
authors.lastname: Valdovinos-Andraca
authors.forename: F
authors.initials: F
authors.lastname: Vargas-Vorackova
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D016009:Chi-Square Distribution; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D034321:Hyperamylasemia / Q000209:etiology*; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D055815:Young Adult
chemical_list: D008049:Lipase; D000681:Amylases