Metabolic and inflammatory responses after ERCP

Background: We aim to evaluate the metabolic and inflammatory responses after ERCP procedure in patients who have common bile duct stones.

Methods: Between September 2009 and October 2010, we studied prospectively 50 patients who diagnosed with common bile duct stones. Our study was included patients who had previously been suspected with common biliary duct stone via radiological and biochemical examinations. We investigated parameters of pro-inflammatory cytokines (IL-1β, IL-6, Il-8, IL-12, IFN-γ, TNF-α), anti inflammatory cytokines (IL-4, IL-10, IL-13), stress hormones (ACTH, cortisol, growth hormone, aldosterone) and acute phase reactant (CRP). All venous blood samples were taken firstly 1hr before endoscopic intervention as a control. After ERCP procedure, venous blood samples were taken two more times, the first in 1hr, the second in 24 hours.

Results: We performed ERCP successfully to 50 patients due to common bile duct stones. All of them had higher serum cytokine levels (p<0.01) after an hour and 24 hours later ERCP than before endoscopic intervention except IL-13 level. A significant increase (p<0,01) was found in ACTH, cortisol, GH and aldosterone levels 1 hour and 24 hours after ERCP, except GH level (p>0.05). CRP level was significiantly increased 1 hour and 24 hours after ERCP.

Conclusion: ERCP procedure is a kind of invasive attempt as known, also causes, with its effects, systemically inflammatory response in the body. This response, mostly not staying at the local stage, becomes systemic inflammatory response. Therefore, before ERCP is performed, the applications of other non-invasive methods of diagnosis are strongly advised.