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World J Gastroenterol. Sep 14, 2017; 23(34): 6201-6211
Published online Sep 14, 2017. doi: 10.3748/wjg.v23.i34.6201
Evidences supporting the vascular etiology of post-double balloon enteroscopy pancreatitis: Study in porcine model
Rafael Latorre, Octavio López-Albors, Federico Soria, Esther Morcillo, Pilar Esteban, Enrique Pérez-Cuadrado-Robles, Enrique Pérez-Cuadrado-Martínez
Rafael Latorre, Octavio López-Albors, Department of Anatomy and Comparative Pathology, University of Murcia, Campus Espinardo, 30100 Murcia, Spain
Federico Soria, Esther Morcillo, Minimally Invasive Surgery Centre Jesús Usón, 10071 Cáceres, Spain
Pilar Esteban, Enrique Pérez-Cuadrado-Robles, Enrique Pérez-Cuadrado-Martínez, Department of Gastroenterology, Small Bowel Unit, Morales Meseguer Hospital, 30008 Murcia, Spain
Author contributions: Latorre R, López-Albors O, Soria F, Morcillo E, Esteban P, Pérez-Cuadrado-Robles E and Pérez-Cuadrado-Martínez E substantially contributed to the conception and design of the study, acquisition, analysis and interpretation of data; all authors drafted the article and made critical revisions related to the intellectual content of the manuscript, and approved the final version of the article to be published.
Supported by Fundacion Seneca, Comunidad Autonoma de la Region de Murcia, Spain, No. 12024/PI/09.
Conflict-of-interest statement: To the best of all authors’ knowledge, no conflict of interest exists.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Octavio López-Albors, DVM, PhD, Professor of Anatomy and Comparative Pathology, Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Campus Universitario de Espinardo, 30100 Murcia, Spain. albors@um.es
Telephone: +34-868-884694 Fax: +34-868-884641
Received: March 28, 2017
Peer-review started: March 31, 2017
First decision: June 5, 2017
Revised: June 28, 2017
Accepted: August 25, 2017
Article in press: August 25, 2017
Published online: September 14, 2017
Abstract

Double balloon enteroscopy (DBE) is an endoscopic technique broadly used to diagnose and treat small bowel diseases. Among the associated complications of the oral DBE, post-procedure pancreatitis has taken the most attention due to its gravity and the thought that it might be associated to the technique itself and anatomical features of the pancreas. However, as the etiology has not been clarified yet, this paper aims to review the published literature and adds new results from a porcine animal model. Biochemical markers, histological sections and the vascular perfusion of the pancreas were monitored in the pig during DBE practice. A reduced perfusion of the pancreas and bowel, the presence of defined hypoxic areas and disseminated necrotic zones were found in the pancreatic tissue of pigs. All these evidences contribute to support a vascular distress as the most likely etiology of the post-DBE pancreatitis.

Keywords: Double balloon enteroscopy, Pancreas, Animal model, Pancreatitis, Pig

Core tip: Double balloon enteroscopy (DBE) has been occasionally associated with pancreatitis. As the etiology has not been clarified yet, this paper reviews the published literature and adds new results from the porcine animal model. Based on a growing number of indirect clinical evidences and supported by experimental studies in animal model, a vascular distress is suggested as the most likely etiology of post-DBE pancreatitis.