Basic Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2016; 22(17): 4330-4337
Published online May 7, 2016. doi: 10.3748/wjg.v22.i17.4330
Effect of the manipulation of the duodenal papilla during double balloon enteroscopy
Rafael Latorre, Octavio López-Albors, Federico Soria, Eugenia Candanosa, Enrique Pérez-Cuadrado
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
Federico Soria, Minimally Invasive Surgery Center Jesús Usón, 10071 Cáceres, Spain
Enrique Pérez-Cuadrado, Unit of Digestive Diseases, Morales Meseguer University Hospital, 30008 Murcia, Spain
Author contributions: Latorre R, López-Albors O, Soria F, Candanosa E and Pérez-Cuadrado E substantially contributed to the conception and design of the study, acquisition, analysis and interpretation of data; all authors drafted the article and made critical revisions related to the intellectual content of the manuscript, and approved the final version of the article to be published.
Supported by the Project 12024/PI/09 (Fundacion Seneca, Comunidad Autonoma de la Region de Murcia, Spain).
Institutional review board statement: The study was reviewed and approved by the “Universidad de Murcia” Institutional Review Board.
Institutional animal care and use committee statement: All procedures involving animals were reviewed and approved by the Institutional Animal Care and Use Committee of the University of Murcia, Spain (No. 452/2009).
Conflict-of-interest statement: To the best of all authors’ knowledge, no conflict of interest exists.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Rafael Latorre, DVM, PhD, Professor of Anatomy and Comparative Pathology, Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Campus Universitario de Espinardo, 30100 Murcia, Spain.
Telephone: +34-868-884697 Fax: +34-869-884641
Received: December 29, 2015
Peer-review started: December 30, 2015
First decision: January 28, 2016
Revised: February 11, 2016
Accepted: March 2, 2016
Article in press: March 2, 2016
Published online: May 7, 2016

AIM: 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.

CONCLUSION: 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.

Keywords: Duodenal papilla, Double balloon enteroscopy, Pancreas, Animal model, Pancreatitis

Core tip: During double balloon enteroscopy (DBE) the manipulation of the duodenal papilla by the inflated balloons around the area of secretion of the pancreas determines structural damage in the organ and increased levels of biochemical markers of pancreatitis. Thus, the widely assumed recommendation of avoiding any contact of the balloons with the duodenal papilla so as to decrease post-DBE pancreatic risk is now supported by empirical results in an animal model.