RESUMO
BACKGROUND: Abdominal pain after bariatric surgery (BS) is frequently observed. Despite numerous diagnostic tests, the cause of abdominal pain is not always found. OBJECTIVES: To quantify type and number of diagnostic tests performed in patients with abdominal pain after BS and evaluate the burden and their yield in the diagnostic process. SETTING: A bariatric center in the Netherlands. METHODS: In this prospective study, we included patients who presented with abdominal pain after BS between December 1, 2020, and December 1, 2021. All diagnostic tests and reoperations performed during one episode of abdominal pain were scored using a standardized protocol. RESULTS: A total of 441 patients were included; 401 (90.9%) were female, median time after BS was 37.0 months (IQR, 11.0-66.0) and mean percentage total weight loss was 31.41 (SD, 10.53). In total, 715 diagnostic tests were performed, of which 355 were abdominal CT scans, 155 were ultrasounds, and 106 were gastroscopies. These tests yielded a possible explanation for the pain in 40.2% of CT scans, 45.3% of ultrasounds, and 34.7% of gastroscopies. The diagnoses of internal herniation, ileus, and nephrolithiasis generally required only 1 diagnostic test, whereas patients with anterior cutaneous nerve entrapment syndrome, irritable bowel syndrome, and constipation required several tests before diagnosis. Even after several negative tests, a diagnosis was still found in the subsequent test: 86.7% of patients with 5 or more tests had a definitive diagnoses. Reoperations were performed in 37.2% of patients. CONCLUSION: The diagnostic burden in patients with abdominal pain following BS is high. The most frequently performed diagnostic test is an abdominal CT scan, yielding the highest number of diagnoses in these patients.
Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Humanos , Feminino , Masculino , Derivação Gástrica/efeitos adversos , Obesidade Mórbida/complicações , Estudos Prospectivos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Cirurgia Bariátrica/efeitos adversos , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Laparoscopia/métodosRESUMO
PURPOSE: Long-term follow-up after bariatric surgery (BS) reveals high numbers of patients with abdominal pain that often remains unexplained. The aim of this prospective study was to give an overview of diagnoses for abdominal pain, percentage of unexplained complaints, number and yield of follow-up visits, and time to establish a diagnosis. MATERIALS AND METHODS: Patients who visited the Spaarne Gasthuis Hospital, The Netherlands, between December 2020 and December 2021 for abdominal pain after BS, were eligible and followed throughout the entire episode of abdominal pain. Distinction was made between presumed and definitive diagnoses. RESULTS: The study comprised 441 patients with abdominal pain; 401 (90.9%) females, 380 (87.7%) had Roux-en-Y gastric bypass, mean (SD) % total weight loss was 31.4 (10.5), and median (IQR) time after BS was 37.0 (11.0-66.0) months. Most patients had 1-5 follow-up visits. Readmissions and reoperations were present in 212 (48.1%) and 164 (37.2%) patients. At the end of the episode, 88 (20.0%) patients had a presumed diagnosis, 183 (41.5%) a definitive diagnosis, and 170 (38.5%) unexplained complaints. Most common definitive diagnoses were cholelithiasis, ulcers, internal herniations, and presumed diagnoses irritable bowel syndrome (IBS), anterior cutaneous nerve entrapment syndrome, and constipation. Median (IQR) time to presumed diagnoses, definitive diagnoses, or unexplained complaints was 16.0 (3.8-44.5), 2.0 (0.0-31.5), and 13.5 (1.0-53.8) days (p < 0.001). Patients with IBS more often had unexplained complaints (OR 95%CI: 4.457 [1.455-13.654], p = 0.009). At the end, 71 patients (16.1%) still experienced abdominal pain. CONCLUSION: Over a third of abdominal complaints after BS remains unexplained. Most common diagnoses were cholelithiasis, ulcers, and internal herniations.
Assuntos
Cirurgia Bariátrica , Colelitíase , Derivação Gástrica , Síndrome do Intestino Irritável , Obesidade Mórbida , Feminino , Humanos , Masculino , Obesidade Mórbida/cirurgia , Estudos Prospectivos , Úlcera , Derivação Gástrica/efeitos adversos , Cirurgia Bariátrica/efeitos adversos , Dor Abdominal/diagnóstico , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Estudos RetrospectivosRESUMO
BACKGROUND: Modern small bowel imaging techniques allow detailed depiction of small-intestinal abnormalities. The role of these techniques in the investigation of celiac disease is increasing, especially in patients with suspected complicated celiac disease. KEY MESSAGES: In general, there is no need for radiological small bowel imaging in uncomplicated celiac disease. It is however important that clinicians and radiologists are aware of certain specific radiological findings that may suggest celiac disease, especially since celiac disease is often not considered in adult patients, and small bowel radiology may be performed before specific tests for celiac disease. Radiological abnormalities can be observed with both conventional small bowel radiology studies, like small bowel follow-through or double-contrast small bowel enteroclysis, and newer modalities, like computed tomography or magnetic resonance enterography or enteroclysis. These signs include a decreased number of jejunal folds, an increased number of ileal folds, small bowel dilatation, wall thickening and intussusception. Extraintestinal abnormalities include mesenteric lymphadenopathy, vascular changes and splenic atrophy. Abnormalities congruent with refractory celiac disease type II include a severe decrease in jejunal folds, infiltration of the mesenteric fat and thickening of the small bowel wall. Additionally, a severely decreased splenic volume may indicate complicated celiac disease. Malignant complications of celiac disease, such as enteropathy-associated T-cell lymphoma and small-intestinal adenocarcinoma, can be reliably investigated with cross-sectional enteroclysis techniques. CONCLUSIONS: Small bowel imaging and especially cross-sectional enteroclysis techniques are important extensions to the diagnostic workup of clinicians involved in the care of patients with celiac disease, especially those with suspected complicated disease.
Assuntos
Doença Celíaca/diagnóstico por imagem , Diagnóstico por Imagem , Intestino Delgado/diagnóstico por imagem , Doença Celíaca/complicações , Humanos , RadiografiaRESUMO
A double-duct sign is the combined dilatation of the common bile duct and pancreatic duct, often caused by cancer of the pancreas. We present a patient with colicky pain in the right upper quadrant of her abdomen. On radiological imaging and endosonography, she had a double-duct sign due to choledocholithiasis and no mass in the pancreatic head. A literature search was performed, which indicated that in selected patients with a higher likelihood of pancreas cancer (for example jaundice or pancreatic mass on radiological imaging) up to 85% of patients do indeed have a pancreatic cancer. In an unselected population, regardless of presenting symptoms, a double-duct sign on endoscopic retrograde cholangiopancreatography (ERCP) was caused by a pancreas malignancy in 58% of patients. In selected patients without jaundice but with a double duct sign, pancreas cancer was only seen in 6% of patients. The sensitivity and specificity of the double-duct sign observed by ERCP for pancreatic cancer varies between 50-76% and 63-80%, respectively. Our patient with symptomatic choledocholithiasis underwent an uncomplicated ERCP with stone extraction and papillotomy and was referred for a cholecystectomy.
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Coledocolitíase/diagnóstico , Ducto Colédoco/patologia , Ductos Pancreáticos/patologia , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/complicações , Coledocolitíase/patologia , Coledocolitíase/cirurgia , Cólica/etiologia , Ducto Colédoco/cirurgia , Diagnóstico Diferencial , Dilatação Patológica , Endossonografia , Feminino , Humanos , Pessoa de Meia-Idade , Ductos Pancreáticos/cirurgia , Neoplasias Pancreáticas/diagnóstico , Valor Preditivo dos Testes , Esfinterotomia Endoscópica , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the diagnostic accuracy of MR enteroclysis and to compare it to video capsule endoscopy (VCE) in the analysis of suspected small-bowel disease. METHODS: We performed a retrospective analysis of 77 patients who underwent both MR enteroclysis and VCE and compared the findings of these studies with the findings of enteroscopy, surgery, or with the results of clinical follow-up lasting ≥2 years. RESULTS: Findings included malignant neoplasms (n = 13), benign neoplasms (n = 10), refractory celiac disease (n = 4), Crohn's disease (n = 2) and miscellaneous conditions (n = 10). Specificity of MR enteroclysis was higher than that of VCE (0.97 vs. 0.84, P = 0.047), whereas sensitivity was similar (0.79 vs. 0.74, P = 0.591). In 2/32 (6.3%) patients with both negative VCE and negative MR enteroclysis a positive diagnosis was established, compared to 5/11 (45.5%) patients in whom VCE was positive and MR enteroclysis was negative (likelihood ratio 8.1; P = 0.004), 9/11 (81.8%) patients in whom MR enteroclysis was positive and VCE was negative (likelihood ratio 23.5; P < 0.0001), and all 23 patients in whom both VCE and MR enteroclysis showed abnormalities (likelihood ratio 60.8; P < 0.0001). CONCLUSIONS: VCE and MR enteroclysis are complementary modalities. In our study-population, MR enteroclysis was more specific than VCE, while both produced the same sensitivity.
Assuntos
Endoscopia por Cápsula , Enteropatias/diagnóstico , Intestino Delgado , Imageamento por Ressonância Magnética/métodos , Distribuição de Qui-Quadrado , Meios de Contraste , Feminino , Humanos , Enteropatias/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
GOALS AND BACKGROUND: Discriminating between patients with nonresponsive but otherwise uncomplicated celiac disease (CD) and patients with refractory celiac disease (RCD) and/or lymphoma is difficult, especially as many abnormalities encountered in complicated CD are not within reach of conventional gastroduodenoscopy. We aimed to describe video capsule endoscopy (VCE) findings in patients with CD and persisting or relapsing symptoms despite a gluten-free diet and to identify VCE findings associated with poor prognosis. METHODS: We retrospectively analyzed 48 VCE studies performed in adult patients with CD because of persisting or relapsing symptoms despite adherence to a gluten-free diet. Patients with either uncomplicated CD or RCD type I were considered to have a good prognosis, whereas patients with either RCD type II or enteropathy-associated T-cell lymphoma were considered to have a poor prognosis. Multivariate analysis was performed to identify VCE findings independently associated with either good or poor prognosis. RESULTS: Proximal focal erythema (odds ratio, 6.7; 95% confidence interval, 1.2-38.7; P=0.033) and absence of progression of the capsule to the distal intestine (odds ratio, 16.5; 95% confidence interval, 1.2-224.9; P=0.035) were independently associated with poor prognosis. Of the 28 patients with none of these 2 features, none died during follow-up, compared with 2 (13.3%) of the 15 patients with one of both features, and 4 (80.0%) of the 5 patients with both the features. CONCLUSIONS: VCE is a minimally invasive endoscopic modality that could be of use in identifying patients with nonresponsive CD who are at risk of poor prognosis.
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Endoscopia por Cápsula/métodos , Doença Celíaca/diagnóstico , Intestino Delgado/patologia , Adulto , Doença Celíaca/patologia , Dieta Livre de Glúten , Progressão da Doença , Linfoma de Células T Associado a Enteropatia/complicações , Linfoma de Células T Associado a Enteropatia/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Estudos RetrospectivosAssuntos
Anemia Ferropriva/etiologia , Angiodisplasia/complicações , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Hemorragia Gastrointestinal/complicações , Doenças do Íleo/complicações , Neoplasias Pulmonares/cirurgia , Angiodisplasia/diagnóstico , Endoscopia por Cápsula , Endoscopia Gastrointestinal , Feminino , Humanos , Doenças do Íleo/diagnóstico , Pessoa de Meia-IdadeAssuntos
Azatioprina/efeitos adversos , Doença de Crohn/tratamento farmacológico , Imunossupressores/efeitos adversos , Nevo Pigmentado/induzido quimicamente , Neoplasias Cutâneas/induzido quimicamente , Azatioprina/administração & dosagem , Azatioprina/uso terapêutico , Colonoscopia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Pé , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Nevo Pigmentado/complicações , Nevo Pigmentado/diagnóstico , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/diagnóstico , Fatores de Tempo , Adulto JovemAssuntos
Colonoscopia , Divertículo do Colo/cirurgia , Idoso , Divertículo do Colo/patologia , Humanos , MasculinoRESUMO
PURPOSE: To determine magnetic resonance (MR) enteroclysis findings in patients with uncomplicated celiac disease (CD), refractory CD (RCD) type I, and RCD type II, to develop and validate a scoring system to identify patients with RCD II and to determine the diagnostic accuracy of MR enteroclysis to detect CD-related malignancies. MATERIALS AND METHODS: This study was performed with approval of the institutional review board. One radiologist blinded to clinical details retrospectively evaluated quantitative and qualitative criteria of 28 studies obtained in symptomatic patients with CD (uncomplicated CD, n = 10; RCD I, n = 8; RCD II, n = 10). A scoring system was developed by using parameters identified in multivariate analysis to be associated with RCD II, which two radiologists evaluated in a second group of 40 symptomatic patients with CD. Accuracy to detect malignancy was assessed in the total study group. Cumulative survival was evaluated in the total study group by using the Kaplan-Meier method. RESULTS: MR enteroclysis could not be used to discriminate between uncomplicated CD and RCD I. The presence of less than 10 folds per 5 cm jejunum, mesenteric fat infiltration, and bowel wall thickening were associated with RCD II. A positive MR score was defined as the presence of two or more of these features. In the validation group, the MR score was positive in 13 of 15 patients with RCD II (sensitivity, 0.87) and negative in 24 of 25 patients without RCD II (specificity, 0.96). The 5-year survival rate was 95% in patients with a negative MR score and 56% in patients with a positive MR score (P < .0001). MR enteroclysis helped to identify the presence of seven of eight malignancies and to diagnose absence of malignancy in 58 of 60 studies. CONCLUSION: MR enteroclysis can be used to investigate the presence of RCD II or malignancy in symptomatic patients with CD.
Assuntos
Algoritmos , Doença Celíaca/diagnóstico , Indicadores Básicos de Saúde , Interpretação de Imagem Assistida por Computador/métodos , Intestino Delgado/patologia , Imageamento por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Método Simples-Cego , Adulto JovemRESUMO
Recently the incidence of oesophageal carcinoma has increased predominantly due to a rise in the incidence of adenocarcinoma. A relationship with the increasing prevalence of Barrett's oesophagus plays an important role. Diagnosis and staging should include oesophago-gastro-duodenoscopy, transoesophageal endo-echography and computer tomography. A higher sensitivity and specificity for distant metastases may possibly be achieved by adding positron emission tomography. In patients with adenocarcinoma neoadjuvant chemoradiotherapy followed by surgery has been associated with better survival. This effect is less convincing in squamous cell carcinomas. Distal and gastro-oesophageal tumours are particularly suitable for a transhiatal approach. Intrathoracic tumours are suitable for a transthoracic resection. There is no difference in survival after the transhiatal or the transthoracic approach, despite the less extensive lymph node dissection in the transhiatal procedure. Minimally invasive oesophagectomy seems to be associated with a lower morbidity and a shorter hospital stay. Randomized trials are needed to substantiate these results.
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Adenocarcinoma/epidemiologia , Neoplasias Esofágicas/epidemiologia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Humanos , Tempo de Internação , Estadiamento de Neoplasias , Resultado do TratamentoRESUMO
OBJECTIVE: To summarise available evidence on diagnostic tests that might help primary care physicians to identify patients with an increased risk for colorectal cancer among those consulting for non-acute lower abdominal symptoms. DATA SOURCES: PubMed, Embase, and reference screening. Study eligibility criteria Studies were selected if the design was a diagnostic study; the patients were adults consulting because of non-acute lower abdominal symptoms; tests included signs, symptoms, blood tests, or faecal tests. Study appraisal and synthesis methods Two reviewers independently assessed quality with a modified version of the QUADAS tool and extracted data. We present diagnostic two by two tables and pooled estimates of sensitivity and specificity. We refrained from pooling when there was considerable clinical or statistical heterogeneity. RESULTS: 47 primary diagnostic studies were included. Sensitivity was consistently high for age >or=50 (range 0.81-0.96, median 0.91), a referral guideline (0.80-0.94, 0.92), and immunochemical faeces tests (0.70-1.00, 0.95). Of these, only specificity of the faeces tests was good. Specificity was consistently high for family history (0.75-0.98, 0.91), weight loss (0.72-0.96, 0.89), and iron deficiency anaemia (0.83-0.95, 0.92), but all tests lacked sensitivity. None of these six tests was (sufficiently) studied in primary care. CONCLUSIONS: Although combinations of symptom and results of immunochemical faeces tests showed good diagnostic performance for colorectal cancer, evidence from primary care is lacking. High quality studies on their role in the diagnostic investigation of colorectal cancer in primary care are urgently needed.
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Neoplasias Colorretais/diagnóstico , Adulto , Idoso , Hemorragia Gastrointestinal/etiologia , Humanos , Pessoa de Meia-Idade , Sangue Oculto , Linhagem , Garantia da Qualidade dos Cuidados de Saúde , Doenças Retais/etiologia , Encaminhamento e Consulta , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Redução de PesoRESUMO
BACKGROUND: Capsule retention in the small bowel is a known complication of small-bowel video capsule endoscopy. Surgery is the most frequently used method of capsule retrieval. OBJECTIVE: To determine the incidence and causes of capsule retention and to describe double-balloon endoscopy (DBE) as the primary technique used for capsule retrieval. DESIGN: Retrospective analysis of all video capsule studies was performed at our center, and evaluation of the outcome of DBE was the first method used to retrieve entrapped video capsules. SETTING: Tertiary referral center. PATIENTS: A total of 904 patients who underwent small-bowel video capsule endoscopy. INTERVENTIONS: Capsule retrieval by DBE. MAIN OUTCOME MEASUREMENTS: The number of patients in whom capsule retention occurred and the number of patients in whom an entrapped capsule could be retrieved by using DBE. RESULTS: Capsule retention occurred in 8 patients (incidence 0.88%; 95% CI, 0.41%-1.80%) and caused acute small-bowel obstruction in 6 patients. All retained capsules were successfully removed during DBE. Five patients underwent elective surgery to treat the underlying cause of capsule retention. One patient required emergency surgery because of multiple small-bowel perforations. LIMITATIONS: Retrospective design. CONCLUSIONS: In our series, the incidence of capsule retention was low. DBE is a reliable method for removing retained capsules and might prevent unnecessary surgery. If surgery is required, preoperative capsule retrieval allows preoperative diagnosis, adequate staging in case of malignancy, and optimal surgical planning.
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Cápsulas Endoscópicas , Endoscopia por Cápsula/efeitos adversos , Remoção de Dispositivo/métodos , Endoscopia Gastrointestinal/métodos , Gastroenteropatias/terapia , Feminino , Humanos , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
PURPOSE: To evaluate the diagnostic accuracy and interobserver variance of magnetic resonance (MR) enteroclysis in the diagnosis of small-bowel neoplasms, with small-bowel endoscopy, surgery, histopathologic analysis, and follow-up serving as standards of reference, and to identify MR enteroclysis characteristics capable of enabling discrimination between benign and malignant small-bowel neoplasms. MATERIALS AND METHODS: This study was performed in accordance with the guidelines of the institutional review board, and the requirement for informed consent was waived. MR enteroclysis studies of 91 patients (43 women, 48 men; age range, 18-83 years) were retrospectively evaluated by two radiologists blinded to clinical details. Only studies explicitly performed to investigate or exclude the presence of small-bowel neoplasms were included. Radiologic findings were compared with findings of double-balloon endoscopy (n = 45), surgery (n = 18), esophagogastroduodenoscopy (n = 3), ileocolonoscopy (n = 2), autopsy (n = 2), and clinical follow-up for more than 18 months (n = 21). Efficacy parameters were calculated with 95% confidence intervals. Tumor characteristics were compared with the Student t test and the Fisher exact test. RESULTS: Readers 1 and 2 interpreted 31 and 33 studies, respectively, as depicting a small-bowel neoplasm and 19 and 17 studies, respectively, as depicting small-bowel malignancy. In 32 patients, the presence of small-bowel neoplasm was confirmed. In 19 of these patients, the neoplasm was malignant. Sensitivity and specificity in the diagnosis of small-bowel neoplasms was 0.91 and 0.95, respectively, for reader 1 and 0.94 and 0.97, respectively, for reader 2; the kappa value was 0.95. Factors associated with malignancy were the presence of longer solitary nonpedunculated lesions, mesenteric fat infiltration, and enlarged mesenteric lymph nodes. CONCLUSION: Eighty-six of 91 studies were correctly interpreted, resulting in an overall diagnostic accuracy of 0.95 for MR enteroclysis in the detection of small-bowel neoplasms. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09090828/-/DC1.
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Neoplasias Intestinais/diagnóstico , Intestino Delgado , Imageamento por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Diagnóstico Diferencial , Endoscopia Gastrointestinal , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Neoplasias Intestinais/patologia , Neoplasias Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Padrões de Referência , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
The field of radiological small bowel imaging is changing rapidly, as is small bowel enteroscopy. New techniques allow the depiction of intraluminal, mural, and extraintestinal features of various small bowel disorders, such as Crohn disease, small bowel polyposis syndromes, small intestinal malignancies, and celiac disease. For patients requiring repeated small bowel imaging, modalities that do not use ionizing radiation, such as ultrasound or magnetic resonance imaging, should be considered.
Assuntos
Doença Celíaca/diagnóstico por imagem , Doença de Crohn/diagnóstico por imagem , Endoscopia Gastrointestinal/métodos , Polipose Intestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Adulto , Idoso , Endoscopia por Cápsula , Cateterismo , Doença Celíaca/diagnóstico , Doença Celíaca/patologia , Doença de Crohn/diagnóstico , Doença de Crohn/patologia , Feminino , Humanos , Polipose Intestinal/diagnóstico , Polipose Intestinal/patologia , Intestino Delgado/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
AIM: To perform a single-center analysis of all double balloon endoscopy (DBE) related cases of pancreatitis identified prospectively from a recorded DBE-complication database. METHODS: From November 2003 until January 2007, 603 DBE procedures were performed on 412 patients, with data on complications recorded in a database. The setting was a tertiary care center offering DBE. DBE was performed from the antegrade or retrograde route. Outcome measurements included age, gender, medication, indication, DBE-endoscope type, insertion depth, procedure duration, findings, interventions, post-procedural abdominal pain, and post-procedural hospitalization. RESULTS: This is the largest single-center study reporting on post-DBE pancreatitis prospectively. Six patients (1.0%) developed post-DBE pancreatitis, all after antegrade DBE. There was no association with gender, duration of the procedure or type of endoscope. The mean age was 51.9 years (range 25-78). Four patients had severe pancreatitis. Of these, two had inflammatory signs in the body-tail region, one had pancreatitis in the tail region, and the total pancreas was involved in one. CONCLUSION: The incidence of post-DBE pancreatitis in our series is higher than previously reported. We found no relation with DBE-endoscope type. The inflammatory changes occurred in the body-tail region of the pancreas, suggesting that post-DBE pancreatitis is caused by repetitive mechanical strain on the pancreas.