The Effect of ERCP on Circulating Pancreatic Enzymes and Pancreatic Protease Inhibitors

Mitchell Conn, Andrew Goldenberg, Linda Concepcion, John Mandeli

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

The pathogenesis of endoscopic retrograde cholangio‐pancreatography (ERCP)‐induced pancreatitis is poorly understood. To elucidate a role for pancreatic enzymes in ERCP‐induced pancreatitis, we measured serum amylase, lipase, trypsin, and elastase in 25 patients undergoing ERCP. Serum α1‐antitrypsin and α2‐macroglobulin, two major pancreatic protease inhibitors, also were measured. All pancreatic enzymes measured rose significantly after ERCP. Pancreatic duct cannulation was associated with a greater elevation in serum amylase and lipase. Circulating α2‐macroglobulin was reduced by 7% 0(p= 0.04) 6 h after ERCP, whereas circulating α1‐antitrypsin increased over the same time period. Papillotomy, stent placement, or underlying disease did not influence changes any further. Three patients developed ERCP‐induced pancreatitis. All three patients had circulating α2‐macroglobulin levels below 243 mg/dl (p= 0.03). The ERCP‐induced alterations in circulating pancreatic enzymes and their inhibitors are similar to changes seen in clinical pancreatitis. Low circulating α2‐macroglobulin levels may predispose to ERCP‐induced pancreatitis.

Original languageEnglish
Pages (from-to)1011-1014
Number of pages4
JournalAmerican Journal of Gastroenterology
Volume86
Issue number8
DOIs
StatePublished - Aug 1991

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