DIAGNOSTIC RELEVANCE OF INTERLEUKIN PATTERN, ACUTE-PHASE PROTEINS, AND PROCALCITONIN IN EARLY PHASE OF POST-ERCP PANCREATITIS

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatiti s has been suggested as a model for acute pancreatitis (AP), which all ows evaluation of early alterations in the time course of the disease. The influence of the clinical course on procalcitonin (PCT), serum am yloid A (SAA), and several proinflammatory and inhibitory cytokines wa s evaluated in patients with AP following ERCP. Blood samples were pro spectively collected from patients undergoing ERCP. The incidence of E RCP-induced pancreatic damage, defined as abdominal complaints, a thre efold increase of serum lipase, and elevation of CRP from <10 to >20 m g/liter was 12.8% (12/94), Only mild clinical courses of acute pancrea titis were observed. PCT significantly increased in subjects with post -ERCP pancreatitis after 24 hr. However, PCT levels did not exceed 0.5 ng/ml in any patient. Interleukin-l receptor antagonist (IL-1RA) bega n to differ from baseline 2 hr after ERCP, followed by interleukin-6 ( IL-6, 6 hr), solubilized tumor necrosis factor-alpha receptor II (sTNF -alpha RII, 24 hr) and SAA (24 hr), Interleukin 10 (IL-10) showed mark ed interindividual variations with no obvious peak. Among all paramete rs evaluated, only peak values of IL-6 and IL-10 showed significant co rrelations with the reported pain score (r(2) = 0.62/0.78), degree of ampullar irritation (r(2) = NS/0.87), and the duration of ERCP (r(2) = 0.58/0.76). No correlation was found with the volume of the injected contrast agent. We conclude that IL-10 and IL-6 appear to be useful to monitor patients after ERCP. The absence of any PCT elevation in the present study is in accordance with the clinical course of the patient s who suffered from mild pancreatic damage without systemic or infecti ous complications.