Hyperamylasemia is associated with increased intestinal permeability in patients undergoing diagnostic oral double-balloon enteroscopy

AIM:To investigate the correlations between serum amylase levels,intestinal permeability(IP),and pancreatic injury and to explore the mechanisms responsible for hyperamylasemia in double-balloon enteroscopy(DBE).METHODS:A prospective study was conducted in 20patients who underwent DBE from August 1,2008 to February 28,2009.Serum amylase was examined 0,2,6 and 24 h post-DBE,C-reactive protein and lipase were examined at 24 h,and urine lactulose,mannitol,and trypsinogen-Ⅱ(TRY-Ⅱ)levels were measured at6 h.Lactulose/mannitol ratio indicated IP,and TRY-Ⅱindicated pancreatic injuries.Procedure duration and enteroscope insertion length were recorded.RESULTS:Twelve patients underwent oral DBE(M:F,5:7;mean age 50.42±11.11 years)and 8 underwent anal DBE(M:F,5:3;mean age 44.75±12.66 years).They all showed significantly increased post-DBE serum amylase.Amylase and lipase levels were higher in the oral DBE group(P<0.05).Hyperamylasemia was diagnosed in 9(75.0%)patients undergoing oral DBE.Only patients receiving oral DBE showed increased postprocedure IP,which correlated with increased serum amylase(r=0.611,P=0.035)and procedure duration(r=0.668,P=0.018).Adverse events included one oral case with pancreatic injury(elevated TRY-Ⅱ)and two cases of abdominal discomfort in each group.Pancreatitis was not reported.CONCLUSION:Hyperamylasemia correlates with increased IP and clinically undetectable pancreatic injuries.DBE could cause intestinal mucosa damage,which may result in IP elevation and increased amylase absorption,necessitating improvements and standardization of DBE methods.