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Endoscopy 2008; 40(6): 506-512
DOI: 10.1055/s-2007-995653
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Severity of post-ERCP pancreatitis directly proportional to the invasiveness of endoscopic intervention: a pilot study in a canine model

J.  M.  Buscaglia1 , B.  W.  Simons2 , B.  J.  Prosser1 , D.  S.  Ruben2 , S.  A.  Giday1 , P.  Magno1 , J.  O.  Clarke1 , E.  J.  Shin1 , A.  N.  Kalloo1 , S.  V.  Kantsevoy1 , K.  L.  Gabrielson1 , S.  B.  Jagannath1
  • 1Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
  • 2Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
Further Information

Publication History

submitted 14 June 2007

accepted after revision 3 February 2008

Publication Date:
14 May 2008 (online)

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Commentaire de travail de J. M. Buscaglia et al., pp. 506Endoscopy 2008; 40(06): 546-546
DOI: 10.1055/s-0032-1306846

Background and study aims: Pancreatitis complicates 1 % - 22 % of endoscopic retrograde cholangiopancreatography procedures. The study aims were to develop a reproducible animal model of post-ERCP pancreatitis (PEP), and investigate the impact of endoscopic technique on severity of PEP.

Patients and methods: ERCP was carried out in six male hound dogs. Pancreatitis was induced by one of three escalating methods: 1) pancreatic acinarization with 20 - 30 mL of contrast; 2) acinarization + ductal balloon occlusion + sphincterotomy; 3) acinarization + intraductal synthetic bile injection + ductal balloon occlusion + sphincterotomy. Dogs 5 and 6 received a pancreatic stent. Necropsy was performed on postoperative day 5. All pancreatic specimens were graded by two blinded pathologists according to a validated scoring system. All dogs were compared with three control dogs.

Results: Dogs 1 - 4 developed clinical pancreatitis and hyperamylasemia (11 736 vs. 722 U/L, P = 0.02). Total injury scores were significantly elevated compared with controls (6.85 vs. 1.06, P = 0.004). There was significant increase in acinar cell necrosis (0.86 vs. 0.06, P = < 0.001), and all other categories (except fibrosis) demonstrated elevated injury scores. Dogs 5 and 6 developed clinical pancreatitis without significant hyperamylasemia; total injury scores were elevated compared with controls (4.83 vs. 1.06, P = 0.01), but lower than in Dogs 1 - 4 (4.83 vs. 6.85, P = 0.25). There was escalating severity of pancreatic injury from Dogs 1 to 4 correlating with the method of endoscopic injury used.

Conclusion: Severity of PEP is directly proportional to invasiveness of endoscopic intervention. Pancreatic acinarization, even without balloon occlusion and sphincterotomy, can be used as a reliable animal model for future studies investigating therapy and prevention of disease.

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J. M. Buscaglia, MD

Johns Hopkins Hospital

1830 E. Monument Street

Room 7100-A

Baltimore MD 21205

USA

Fax: +1-410-955-2108

Email: jbuscaglia@jhmi.edu

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