Neutrophil activation and hyperamylasaemia after endoscopic retrograde cholangiopancreatography: Potential role for the leukocyte in the pathogenesisof acute pancreatitis
Dv. Mann et al., Neutrophil activation and hyperamylasaemia after endoscopic retrograde cholangiopancreatography: Potential role for the leukocyte in the pathogenesisof acute pancreatitis, ENDOSCOPY, 33(5), 2001, pp. 448-453
Background and Study Aims: Hyperamylasaemia occurs in up to 60% of patients
following endoscopic retrograde cholangiopancreatography (ERCP), and in a
small proportion of patients (1-5%) acute pancreatitis may develop. We eval
uated the role of the neutrophil in post-ERCP hyperamylasaemia and acute pa
ncreatitis by measuring circulating CD11b adhesion receptor expression - an
indicator of leukocyte activation.
Patients and Methods: A total of 43 patients undergoing elective ERCP were
studied. Peripheral blood measurements of amylase activity and neutrophil C
D11b content (by flow cytometry) were made immediately before ERCP (baselin
e), and at 2 and 24 hours after the procedure,
Results: ERCP induced an increase in amylase level above baseline in 41 of
43 patients, The 2-hour and 24-hour post-ERCP amylase levels were directly
related (R = 0.9, P < 0.01), Baseline CD11b receptor status was positively
correlated with post-ERCP amylase activity (R = 0.4, P < 0.05), and this re
lationship was stronger when pancreatography had been performed (R = 0.67,
P < 0.01), Three patients (7%) developed clinical acute pancreatitis, with
post-ERCP amylase levels persistently elevated above 1000IU/l, Multiple lin
ear regression identified CD11b expression as the most significant explanat
ory variable for amylase level after ERCP (multiple R = 0.74, P < 0.01).
Conclusions: The findings from this pilot study indicate an association bet
ween neutrophil activation and hyperamylasaemia following ERCP, and suggest
a role for this leukocyte in the pathogenesis of pancreatitis. Further stu
dy of neutrophil characteristics may allow identification of individual sus
ceptibility to ERCP-induced pancreatic injury.