C-reactive protein (CRP) and interleukin-6 (IL-6) are elevated in acute pancreatitis. Limited studies have evaluated their role in ERCP-induced pancreatitis. The aim of this study was to assess the role of serum lipase, CRP, and IL-6 in ERCP-induced pancreatitis.
Eighty-five patients (62 women, 23 men; mean age 43 years; range 16-85 years) who underwent ERCP were entered in a prospective trial. ERCP-induced pancreatitis was classified as mild, moderate, or severe. Serum levels of lipase, CRP, and IL-6 were measured before ERCP and at 12 to 24 hours and 36 to 48 hours after ERCP.
Mild, moderate, and severe pancreatitis occurred, respectively, in 9, 7, and 4 patients after ERCP. There were significant differences in levels of CRP and IL-6 but not lipase for patients with mild versus moderate and moderate versus severe pancreatitis. The mean CRP levels (mg/dL) at 12 to 24 hours were 0.98 +/- 0.24 in mild pancreatitis, 3.89 +/- 0.32 in moderate pancreatitis, and 12.0 +/- 1.60 in severe pancreatitis. The levels, respectively, at 36 to 48 hours were 1.60 +/- 0.31, 7.60 +/- 0.74, and 25.0 +/- 2.9. The mean IL-6 levels (pg/mL) at 12 to 24 hours were 16.6 +/- 2.06 in mild pancreatitis, 73.0 +/- 15.60 in moderate pancreatitis, and 235.5 +/- 26.31 in severe pancreatitis. The levels at 36 to 48 hours were, respectively, 18.92 +/- 3.28, 100.17 +/- 11.56, and 438.2 +/- 71.50.
Serum CRP and IL-6 levels may be useful early markers for predicting the severity of ERCP-induced pancreatitis.
"Finally, the hypothesis of the activation of chemokines by endoscopic maneuvers as a cause of acute pancreatitis cannot be ruled out . Recent studies [98,99,100,101] have indicated the usefulness of ERCP as a model for studying the early inflammatory response in acute pancreatitis. In their study, Kiviniemi et al.  found that, in uncomplicated cases, acute phase response determined by serum C-reactive protein levels was rare and did not parallel the serum amylase or lipase levels. "
[Show abstract][Hide abstract] ABSTRACT: The resulting pain is the main symptom of acute pancreatitis and it should be alleviated as soon as possible. NSAIDs are the first line therapy for pain and they are generally administered to acute pancreatitis patients upon admission to the hospital. In addition, these drugs have also been used to prevent post-endoscopic cholangiopancreatography (ERCP) acute pancreatitis. On the other hand, there are several reports indicating that NSAIDs may be the actual cause of acute pancreatitis. We carried out a literature search on PubMed/MEDLINE; all full text papers published in from January 1966 to November 2009 on the use of NSAIDs in acute pancreatitis were collected; the literature search was also supplemented by a review of the bibliographies of the papers evaluated. Thus, in this article, we will systematically review the current literature in order to better illustrate the role of NSAIDs in acute pancreatitis, in particular: i) NSAIDs as a cause of acute pancreatitis; ii) their use to prevent post-retrograde ERCP pancreatitis and iii) their efficacy for pain relief in the acute illness of the pancreas.
"CRP levels in both ERCP groups were also not different
from the control group patients. Our findings may be explained by CRP being a late marker
in the laboratory monitoring of post-ERCP pancreatitis . Its changes are
commonly initiated at least 24 hours after ERCP . "
[Show abstract][Hide abstract] ABSTRACT: Acute pancreatitis is the major complication of endoscopic retrograde cholangiopancreatography (ERCP) procedure and there are some reports showing cytokine changes in ERCP-induced pancreatits.
To investigate the association between early changes (within 24 hours) in the serum interleukin (IL)-2, IL-4, tumor necrosis factor (TNF)alpha, and IL-6 levels and the development of post-ERCP pancreatitis.
Forty five consecutive patients who underwent therapeutic ERCP and 10 patients with acute pancreatitis without ERCP were enrolled to the study. Serum concentrations of IL-2, IL-4, TNFalpha, and IL-6 were determined immediately before, 12 hours and 24 hours after ERCP.
Seven of the 45 patients (15.5%) developed post-ERCP pancreatitis. The levels of IL-4 at 24 hours after ERCP were significantly lower in the patients with post-ERCP pancreatitis than in those without pancreatitis, while TNFalpha levels at 12 hours after ERCP were higher in the complicated group than those of the uncomplicated group. The ratios of TNFalpha/IL-4 at 12 and 24 hours after ERCP were found significantly higher in the patients with post-ERCP pancreatitis than in those without pancreatitis. IL-6 in the complicated patients was found significantly increased at 24 hours after ERCP.
The enhancement of serum TNFalpha and IL-6 levels in the patients with ERCP-induced pancreatitis reflects the inflammatory activity. Additionally, these cytokines together with IL-4 can be used in clinical laboratory monitoring of ERCP.
[Show abstract][Hide abstract] ABSTRACT: Results: EPO was shown to increase leukocyte counts in the early phase (P < 0.05) though the effect diminished in time. It also had an increasing effect on amylase in the early hours (P < 0.005), but the difference between the groups disappeared in the following hours. No effect was demonstrated on serum CRP. Pancreatic tissue revealed moderate degree of pancreatitis in group III sacrificed at 6 hours and in group IV evaluated at 6 and 24 hours. Despite the absence of a difference in the numerical analysis of Spormann scoring (P > 0.05), moderate pancreatitis developed in the group receiving EPO. Conclusions: The results we have obtained demonstrate that more controlled models (employing low rates of sodium taurocholate or edematous pancreatitis) are necessary to better investigate the efficacy of EPO. Bulgular: Erken saatlerde EPO'nun lökosit deerlerini art›rd›¤› (P < 0.05) ancak zaman geçtikçe etkisinin siliklefltii tespit edilmifltir. Amilaz üzerine de erken saatte art›r›c› etki gösterdii (P < 0.005), ilerleyen saatlerde gruplar aras›nda fark kalmad›¤›n› göstermifltir. Serum CRP'si üzerine herhangi bir etkisi ortaya konulamam›flt›r. Pankreas dokusunda, rakamsal olarak 6.saatte sakrifiye edilen III. grupta ve 6. ve 24. saatlerde incelenen IV. gruplarda orta fliddette pankreatite rastlanm›flt›r. Sporman skorlamas›n›n rakamsal analizinde anlaml› farkl›l›k olmamas›na (P > 0,05) karfl›n, ortaya ç›kan orta fliddetteki pankreatit EPO verilen gruplarda oluflmufltur. Sonuç: Lökosit ve amilaz deerlerinde erken saatlerdeki anlaml› farkl›l›k ilerleyen saatlerde belirsizleflmifltir. Histopatolojik olarak modelin yaratt›¤› fliddetli tablo nedeniyle, daha kontrollü pankreatit tablosunda (düflük oranl› Na taurokolat kullan›lan veya ödematöz pankreatit oluflturulan modellerde) EPO'nun etkinlii, ortaya aç›k olarak konabilir. EPO'nun amilaz ve lökosit üzerine etkisi olduu ön görülmekle birlikte, hafif pankreatit tablosunda etki, daha net gözlenebilir.
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