title: Effect of the manipulation of the duodenal papilla during double balloon enteroscopy.
abstract: OBJECTIVE
  To determine the hypothesis that inflating the balloons in the duodenal papilla determines changes in the biochemical markers of pancreatitis.
  
  
  METHODS
  Four groups of pigs were used: Group papilla (GP), the overtube's balloon was inflated in the area of the papilla; GP + double balloon enteroscopy (GP + DBE), the overtube's balloon was kept inflated in the area of the papilla for 20 min before a DBE; Group DBE (GDBE), DBE was carried out after insuring the balloon's inflation far from the pancreatic papilla; and Group control (GC). Serum concentrations of amylase, lipase and C-reactive protein (CRP) were evaluated. Pancreases were processed for histopathology examination.
  
  
  RESULTS
  Main changes occurred 24 h after the procedure compared with baseline levels. Amylase levels increased significantly in GP (59.2% higher) and were moderately higher in groups GP + DBE and GDBE (22.7% and 20%, respectively). Lipase increased in GP and GP + DBE, whereas it hardly changed in GDBE and in GC. CRP increased significantly in GP, GP + DBE and GDBE, while no changes were reported for GC. No statistically significant difference between groups GP and GP + DBE was found for the histopathological findings, except for vacuolization and necrosis of the pancreatic parenchyma that was higher in GP than in GP + DBE.
  
  
  CONCLUSIONS
  The manipulation of the duodenal papilla by the inflated overtube's balloon during DBE causes pancreatic structural damage and increased biochemical markers associated with pancreatitis.
authors.affiliation: Rafael Latorre, Octavio López-Albors, Eugenia Candanosa, Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Campus Universitario de Espinardo, 30100 Murcia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Latorre
authors.affiliation: Rafael Latorre, Octavio López-Albors, Eugenia Candanosa, Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Campus Universitario de Espinardo, 30100 Murcia, Spain.
authors.forename: Octavio
authors.initials: O
authors.lastname: López-Albors
authors.affiliation: Rafael Latorre, Octavio López-Albors, Eugenia Candanosa, Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Campus Universitario de Espinardo, 30100 Murcia, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Soria
authors.affiliation: Rafael Latorre, Octavio López-Albors, Eugenia Candanosa, Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Campus Universitario de Espinardo, 30100 Murcia, Spain.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Candanosa
authors.affiliation: Rafael Latorre, Octavio López-Albors, Eugenia Candanosa, Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Campus Universitario de Espinardo, 30100 Murcia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Pérez-Cuadrado
mesh_terms: D014670:Ampulla of Vater; D000681:Amylases / Q000097:blood; D000818:Animals; D002097:C-Reactive Protein / Q000032:analysis; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects*; D008049:Lipase / Q000097:blood; D010179:Pancreas / Q000473:pathology; D010195:Pancreatitis / Q000209:etiology*; D013552:Swine
chemical_list: D002097:C-Reactive Protein; D008049:Lipase; D000681:Amylases
keywords: Animal model; Double balloon enteroscopy; Duodenal papilla; Pancreas; Pancreatitis