The effect of ERCP on circulating pancreatic enzymes and pancreatic protease inhibitors

Am J Gastroenterol. 1991 Aug;86(8):1011-4.


The pathogenesis of endoscopic retrograde cholangiopancreatography (ERCP)-induced pancreatitis is poorly understood. To elucidate a role for pancreatic enzymes in ERCP-induced pancreatitis, we measured serum amylase, lipase, trypsin, and elastase in 25 patients undergoing ERCP. Serum alpha 1-antitrypsin and alpha 2-macroglobulin, two major pancreatic protease inhibitors, also were measured. All pancreatic enzymes measured rose significantly after ERCP. Pancreatic duct cannulation was associated with a greater elevation in serum amylase and lipase. Circulating alpha 2-macroglobulin was reduced by 7% (p = 0.04) 6 h after ERCP, whereas circulating alpha 1-antitrypsin increased over the same time period. Papillotomy, stent placement, or underlying disease did not influence changes any further. Three patients developed ERCP-induced pancreatitis. All three patients had circulating alpha 2-macroglobulin levels below 243 mg/dl (p = 0.03). The ERCP-induced alterations in circulating pancreatic enzymes and their inhibitors are similar to changes seen in clinical pancreatitis. Low circulating alpha 2-macroglobulin levels may predispose to ERCP-induced pancreatitis.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Alpha-Globulins / analysis*
  • Amylases / blood
  • Analysis of Variance
  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects*
  • Female
  • Humans
  • Hydrolases / blood*
  • Lipase / blood
  • Male
  • Middle Aged
  • Pancreas / enzymology*
  • Pancreatic Elastase / blood
  • Pancreatitis / enzymology*
  • Pancreatitis / etiology*
  • Trypsin / blood
  • alpha 1-Antitrypsin / analysis
  • alpha-Macroglobulins / analysis


  • Alpha-Globulins
  • alpha 1-Antitrypsin
  • alpha-Macroglobulins
  • Hydrolases
  • Lipase
  • Amylases
  • Pancreatic Elastase
  • Trypsin