title: Hyperamylasemia is associated with increased intestinal permeability in patients undergoing diagnostic oral double-balloon enteroscopy.
abstract: OBJECTIVE
  To investigate the correlations between serum amylase levels, intestinal permeability (IP), and pancreatic injury and to explore the mechanisms responsible for hyperamylasemia in double-balloon enteroscopy (DBE).
  
  
  METHODS
  A prospective study was conducted in 20 patients who underwent DBE from August 1, 2008 to February 28, 2009. Serum amylase was examined 0, 2, 6 and 24 h post-DBE, C-reactive protein and lipase were examined at 24 h, and urine lactulose, mannitol, and trypsinogen-II (TRY-II) levels were measured at 6 h. Lactulose/mannitol ratio indicated IP, and TRY-II indicated pancreatic injuries. Procedure duration and enteroscope insertion length were recorded.
  
  
  RESULTS
  Twelve patients underwent oral DBE (M:F, 5:7; mean age 50.42 ± 11.11 years) and 8 underwent anal DBE (M:F, 5:3; mean age 44.75 ± 12.66 years). They all showed significantly increased post-DBE serum amylase. Amylase and lipase levels were higher in the oral DBE group (P < 0.05). Hyperamylasemia was diagnosed in 9 (75.0%) patients undergoing oral DBE. Only patients receiving oral DBE showed increased post-procedure IP, which correlated with increased serum amylase (r = 0.611, P = 0.035) and procedure duration (r = 0.668, P = 0.018). Adverse events included one oral case with pancreatic injury (elevated TRY-II) and two cases of abdominal discomfort in each group. Pancreatitis was not reported.
  
  
  CONCLUSIONS
  Hyperamylasemia correlates with increased IP and clinically undetectable pancreatic injuries. DBE could cause intestinal mucosa damage, which may result in IP elevation and increased amylase absorption, necessitating improvements and standardization of DBE methods.
authors.affiliation: Nan Feng, Emergency Department, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Feng
authors.affiliation: Nan Feng, Emergency Department, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Dai
authors.affiliation: Nan Feng, Emergency Department, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Lu
authors.affiliation: Nan Feng, Emergency Department, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
authors.forename: Xiao-Bo
authors.initials: XB
authors.lastname: Li
authors.affiliation: Nan Feng, Emergency Department, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
authors.forename: Yun-Jie
authors.initials: YJ
authors.lastname: Gao
authors.affiliation: Nan Feng, Emergency Department, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
authors.forename: Zhi-Zheng
authors.initials: ZZ
authors.lastname: Ge
mesh_terms: D000328:Adult; D000681:Amylases / Q000097:blood*; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D034321:Hyperamylasemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000293:injuries*; D008297:Male; D008358:Mannose / Q000652:urine; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D010539:Permeability; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000681:Amylases; D008358:Mannose
keywords: Double-balloon enteroscopy; Hyperamylasemia; Intestinal permeability; Mechanism; Pancreatitis