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Insulin Resistance as a Novel Risk Factor for Post-ERCP Pancreatitis: A Pilot Study

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Abstract

Background and Aims

The relationship between insulin resistance and post-ERCP pancreatitis (PEP) is not known. We aimed to determine the relation between pre-ERCP insulin resistance and risk of PEP, and to evaluate the relationship of insulin resistance with well-established risk factors for PEP.

Methods

Consecutive patients who underwent ERCP with the diagnosis of choledocolithiasis between January and December 2013 were enrolled in this prospective study. Pre-procedural insulin resistance state and other risk factors were evaluated according to PEP development.

Results

Pancreatitis developed in 16 (11.3 %) of 141 ERCP procedure. Homeostasis model assessment of insulin resistance (HOMA-IR) levels was found statistically significantly higher in patients who developed PEP than the ones who did not (3.37 ± 0.8 vs. 2.38 ± 1.4, p < 0.001). Common bile duct (CBD) diameter of the patients developing PEP was found significantly lower than the non-PEP group (10.1 ± 4 vs. 13.4 ± 4.5 mm, p = 0.01). Mean procedure time was 33.5 min in PEP group and 27.9 min in non-PEP group (p = 0.006). HOMA-IR (OR 2.39), procedure time (OR 1.15), and CBD diameter (OR 0.82) were independent predictors of PEP development.

Conclusions

The presence of insulin resistance is an important risk factor for PEP, and these data can be used as a considerable clue to predict the risk of PEP before ERCP and to decrease related morbidity.

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References

  1. Freeman ML. Post-ERCP pancreatitis: patient and technique-related risk factors. JOP J Pancreas. 2002;3:169–176.

    Google Scholar 

  2. Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998;48:1–10.

    Article  CAS  PubMed  Google Scholar 

  3. Dickinson RJ, Davies S. Post-ERCP pancreatitis and hyperamylasaemia: the role of operative and patient factors. Eur J Gastroenterol Hepatol. 1998;10:423–428.

    Article  CAS  PubMed  Google Scholar 

  4. Wang P, Li Z-S, Liu F, et al. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol. 2009;104:31–40.

    Article  PubMed  Google Scholar 

  5. Cotton PB, Garrow DA, Gallagher J, et al. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc. 2009;70:80–88.

    Article  PubMed  Google Scholar 

  6. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001;96:417–423.

    Article  CAS  PubMed  Google Scholar 

  7. Christoforidis E, Goulimaris I, Kanellos I, et al. Post-ERCP pancreatitis and hyperamylasemia: patient-related and operative risk factors. Endoscopy. 2002;34:286–292.

    Article  CAS  PubMed  Google Scholar 

  8. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–111.

    Article  PubMed  Google Scholar 

  9. Thaker AM, Mosko JD, Berzin TM. Post-endoscopic retrograde cholangiopancreatography pancreatitis. Gastroenterol Rep. 2015;3:32–40.

    Article  Google Scholar 

  10. Chen J-J, Wang X-M, Liu X-Q, et al. Risk factors for post-ERCP pancreatitis: a systematic review of clinical trials with a large sample size in the past 10 years. Eur J Med Res. 2014;19:26.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001;54:425–434.

    Article  CAS  PubMed  Google Scholar 

  12. Badalov N, Tenner S, Baillie J. The Prevention, recognition and treatment of post-ERCP pancreatitis. JOP J Pancreas. 2009;10:88–97.

    Google Scholar 

  13. Sahakian AB, Buxbaum JL, Van Dam J. Prevention and management of Post-ERCP Pancreatitis. JOP J Pancreas. 2014;15:544–551.

    Google Scholar 

  14. Testoni PA. Unresolved issues about post-ERCP pancreatitis: an overview. JOP J Pancreas. 2002;3:156–161.

    Google Scholar 

  15. Pezzilli R, Romboli E, Campana D, Corinaldesi R. Mechanisms involved in the onset of post-ERCP pancreatitis. JOP J Pancreas. 2002;3:162–168.

    Google Scholar 

  16. Ito K, Fujita N, Noda Y, et al. Relationship between post-ERCP pancreatitis and the change of serum amylase level after the procedure. World J Gastroenterol. 2007;13:3855–3860.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Messmann H, Vogt W, Holstege A, et al. Post-ERP pancreatitis as a model for cytokine induced acute phase response in acute pancreatitis. Gut. 1997;40:80–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Leung PS, Chan YC. Role of oxidative stress in pancreatic inflammation. Antioxid Redox Signal. 2009;11:135–165.

    Article  CAS  PubMed  Google Scholar 

  19. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet. 2005;365:1415–1428.

    Article  CAS  PubMed  Google Scholar 

  20. Asrih M, Jornayvaz FR. Inflammation as a potential link between nonalcoholic fatty liver disease and insulin resistance. J Endocrinol. 2013;218:R25–R36.

    Article  CAS  PubMed  Google Scholar 

  21. Alberti KGMM, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; american heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation. 2009;120:1640–1645.

    Article  CAS  PubMed  Google Scholar 

  22. Aroor AR, McKarns S, Demarco VG, et al. Maladaptive immune and inflammatory pathways lead to cardiovascular insulin resistance. Metabolism. 2013;62:1543–1552.

    Article  CAS  PubMed  Google Scholar 

  23. Stefan N, Kantartzis K, Machann J, et al. Identification and characterization of metabolically benign obesity in humans. Arch Intern Med. 2008;168:1609–1616.

    Article  PubMed  Google Scholar 

  24. Apovian CM, Bigornia S, Mott M, et al. Adipose macrophage infiltration is associated with insulin resistance and vascular endothelial dysfunction in obese subjects. Arterioscler Thromb Vasc Biol. 2008;28:1654–1659.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Ozkul A, Ayhan M, Akyol A, et al. The effect of insulin resistance on inflammatory response and oxidative stress in acute cerebral ischemia. Neuro Endocrinol Lett. 2013;34:52–57.

    CAS  PubMed  Google Scholar 

  26. Caccamo G, Bonura F, Bonura F, et al. Insulin resistance and acute coronary syndrome. Atherosclerosis. 2010;211:672–675.

    Article  CAS  PubMed  Google Scholar 

  27. Frossard J-L, Lescuyer P, Pastor CM. Experimental evidence of obesity as a risk factor for severe acute pancreatitis. World J Gastroenterol. 2009;15:5260–5265.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Deenadayalu VP, Blaut U, Watkins JL, et al. Does obesity confer an increased risk and/or more severe course of post-ERCP pancreatitis? A retrospective, multicenter study. J Clin Gastroenterol. 2008;42:1103–1109.

    Article  PubMed  Google Scholar 

  29. Pokhrel B, Choi EK, Khalid O, et al. Increased fat in pancreas not associated with risk of pancreatitis post-endoscopic retrograde cholangiopancreatography. Clin Exp Gastroenterol. 2014;7:199–204.

    PubMed  PubMed Central  Google Scholar 

  30. Iorgulescu A, Sandu I, Turcu F, Iordache N. Post-ERCP acute pancreatitis and its risk factors. J Med Life. 2013;6:109–113.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Testoni PA, Mariani A, Giussani A, et al. Risk factors for post-ERCP pancreatitis in high- and low-volume centers and among expert and non-expert operators: a prospective multicenter study. Am J Gastroenterol. 2010;105:1753–1761.

    Article  PubMed  Google Scholar 

  32. Katsinelos P, Lazaraki G, Chatzimavroudis G, et al. Risk factors for therapeutic ERCP-related complications: an analysis of 2,715 cases performed by a single endoscopist. Ann Gastroenterol Q Publ Hell Soc Gastroenterol. 2014;27:65–72.

    Google Scholar 

  33. Testoni PA. Why the incidence of post-ERCP pancreatitis varies considerably? Factors affecting the diagnosis and the incidence of this complication. J Pancreas. 2002;3:195–201.

    Google Scholar 

  34. Hernández Garcés HR, Almeida Linnet A, Abreu Vázquez MDR, et al. Risk factors associated with the development of hyperamylasemia and post-ERCP pancreatitis in the Cuban National Institute. Rev Gastroenterol Perú Órgano Soc Gastroenterol Perú. 2014;34:127–132.

    Google Scholar 

  35. Leghari A, Ghazanfar S, Qureshi S, et al. Frequency and risk factors in the post-ERCP pancreatitis in a tertiary care centre. J Coll Phys Surg Pak. 2013;23:620–624.

    Google Scholar 

  36. Jacobson BC, Carr-Locke DL. Hypotension during ERCP is common but not a risk factor for post-ERCP pancreatitis. HPB. 2001;3:169–173.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Beyazit Y, Sayilir A, Torun S, et al. Mean platelet volume as an indicator of disease severity in patients with acute pancreatitis. Clin Res Hepatol Gastroenterol. 2012;36:162–168.

    Article  PubMed  Google Scholar 

  38. Nakai Y, Isayama H, Sasahira N, et al. Risk factors for post-ERCP pancreatitis in wire-guided cannulation for therapeutic biliary ERCP. Gastrointest Endosc. 2015;81:119–126.

    Article  PubMed  Google Scholar 

  39. Yashima Y, Isayama H, Tsujino T, et al. A large volume of visceral adipose tissue leads to severe acute pancreatitis. J Gastroenterol. 2011;46:1213–1218.

    Article  PubMed  Google Scholar 

  40. Oskarsson V, Sadr-Azodi O, Orsini N, et al. High dietary glycemic load increases the risk of non-gallstone-related acute pancreatitis: a prospective cohort study. Clin Gastroenterol Hepatol. 2014;12:676–682.

    Article  CAS  PubMed  Google Scholar 

  41. Noel RA, Braun DK, Patterson RE, Bloomgren GL. Increased risk of acute pancreatitis and biliary disease observed in patients with type 2 diabetes: a retrospective cohort study. Diabetes Care. 2009;32:834–838.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Brochu M, Starling RD, Tchernof A, et al. Visceral adipose tissue is an independent correlate of glucose disposal in older obese postmenopausal women. J Clin Endocrinol Metab. 2000;85:2378–2384.

    CAS  PubMed  Google Scholar 

  43. Tulloch-Reid MK, Hanson RL, Sebring NG, et al. Both subcutaneous and visceral adipose tissue correlate highly with insulin resistance in african americans. Obes Res. 2004;12:1352–1359.

    Article  CAS  PubMed  Google Scholar 

  44. Kumar N, Gergi MA, Thompson CC. Obesity is an independent risk factor for post-ERCP pancreatitis: results of a nationwide database analysis [Abstract]. Gastrointest Endosc. 2012;75:AB142.

  45. Johnson GK, Geenen JE, Johanson JF, et al. Evaluation of post-ERCP pancreatitis: potential causes noted during controlled study of differing contrast media. Midwest Pancreaticobiliary Study Group. Gastrointest Endosc. 1997;46:217–222.

    Article  CAS  PubMed  Google Scholar 

  46. Cennamo V, Fuccio L, Zagari RM, et al. Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? Meta-analysis of randomized controlled trials. Endoscopy. 2010;42:381–388.

    Article  CAS  PubMed  Google Scholar 

  47. Mehta PP, Sanaka MR, Parsi MA, et al. Association of procedure length on outcomes and adverse events of endoscopic retrograde cholangiopancreatography. Gastroenterol Rep. 2014;2:140–144.

    Article  Google Scholar 

  48. Technology Committee ASGE, Kethu SR, Adler DG, Diehl DL, et al. ERCP cannulation and sphincterotomy devices. Gastrointest Endosc. 2010;71:435–445.

    Article  Google Scholar 

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Acknowledgments

Special thanks to biostatistician Sinan IYIGUN for advising and performing advanced statistical analyses.

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Authors and Affiliations

  1. Department of Gastroenterology, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Av. Etfal St. 34371 Sisli, Istanbul, Turkey

    Ali Riza Koksal, Salih Boga, Huseyin Alkim, Mehmet Bayram, Meltem Ergun & Canan Alkim

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  1. Ali Riza Koksal
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  2. Salih Boga
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Correspondence to Ali Riza Koksal.

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Koksal, A.R., Boga, S., Alkim, H. et al. Insulin Resistance as a Novel Risk Factor for Post-ERCP Pancreatitis: A Pilot Study. Dig Dis Sci 61, 2397–2405 (2016). https://doi.org/10.1007/s10620-016-4127-0

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  • DOI: https://doi.org/10.1007/s10620-016-4127-0

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