Published online Sep 14, 2017. doi: 10.3748/wjg.v23.i34.6201
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
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.
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.