Introduction Hyperamylasaemia and acute pancreatitis are potential complications following a double balloon enteroscopy (DBE) procedure. The mechanism of these complications is not fully understood. We present a prospective analysis of all patients undergoing DBE at a tertiary centre.
Method Single centre, prospective study involving all consecutive patients attending for DBE by either route, between 23rdAug 2012 and 3rdOctober 2014. Serum amylase levels were obtained before and three hours after the procedure. Clinical evaluation for signs and symptoms of pancreatitis was performed three hours after the procedure. A record of the procedure duration, insertion depth and number of passes was also documented. Hyperamylasaemia was defined as an elevation of the serum amylase level to greater than the upper limit of normal.
Results 115 procedures were performed on 89 patients, mean age 57.4 years (21–83 years), 46 male (51.7%). Indication for procedure is presented in Table 1. 91 procedures were performed per orally and 24 via the anal route. 88 procedures were performed on the basis of a positive small bowel capsule endoscopy (SBCE), 9 patients did not have prior SBCE due to failure to excrete the patency capsule. Indication for DBE is presented in Table 1. Overall 47 patients (61%) had an elevated serum amylase post procedure. Hyperamylasaemia post-procedure was observed in significantly more patients following per-oral DBE compared to DBE via the anal route (p = 0.03). Hyperamylasaemia in the per-oral group was associated with procedure depth (mean 147 cm vs 187 cm p < 0.0009) and number of passes (mean 10 vs 18 p < 0.0007), but not procedure duration (mean 64 vs 70 mins p = 0.2) or dose of fentanyl administered (mean 108 mcg vs 118 mcg p = 0.6). No patients developed signs or symptoms of pancreatitis post-procedure.
Conclusion Hyperamylasaemia is common following DBE per-orally and is associated with procedure depth and number of passes. However, in the majority of cases this is of limited clinical significance and no patients in our series went on to develop pancreatitis.
Disclosure of interest None Declared.