Brief Article
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World J Gastroenterol. Jan 14, 2014; 20(2): 539-545
Published online Jan 14, 2014. doi: 10.3748/wjg.v20.i2.539
Hyperamylasemia is associated with increased intestinal permeability in patients undergoing diagnostic oral double-balloon enteroscopy
Nan Feng, Jun Dai, Hong Lu, Xiao-Bo Li, Yun-Jie Gao, Zhi-Zheng Ge
Nan Feng, Emergency Department, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Jun Dai, Hong Lu, Xiao-Bo Li, Yun-Jie Gao, Zhi-Zheng Ge, Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Key Laboratory of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Shanghai 200127, China
Author contributions: Feng N and Dai J contributed equally to this work; Dai J and Ge ZZ were the principal investigators and supervised the implementation of the study; Feng N and Dai J wrote the protocol, analyzed the data and interpreted the findings; Dai J and Li XB were responsible for the coordination of clinical activities, technical support and data collection; Feng N, Dai J and Lu H wrote and finalized the manuscript; Gao YJ and Ge ZZ provided counseling for implementation and contributed to data monitoring; all authors had full access to the primary data and the final analysis, and approved the latest version of the manuscript.
Correspondence to: Zhi-Zheng Ge, MD, Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Key Laboratory of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Shanghai 200127, China. zhizhengge@aliyun.com
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Received: August 7, 2013
Revised: September 29, 2013
Accepted: November 12, 2013
Published online: January 14, 2014
Processing time: 165 Days and 3.1 Hours
Abstract

AIM: 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-IIindicated 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.

CONCLUSION: 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.

Keywords: Double-balloon enteroscopy; Hyperamylasemia; Intestinal permeability; Pancreatitis; Mechanism

Core tip: Hyperamylasemia, or increased serum amylase, and acute pancreatitis following double-balloon enteroscopy (DBE) have been reported in patients receiving diagnostic DBE, particularly oral DBE.