Early changes of serum proinflammatory and anti-inflammatory cytokines after endoscopic retrograde cholangiopancreatography.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP)-induced pancreatitis provides a model to study the time course of cytokine release during the initiation phase of pancreatitis. The early changes of inflammatory cytokines after ERCP have been unclear.

Aims: To evaluate the early changes in serum levels of proinflammatory and antiinflammatory cytokines after ERCP and to assess their value in the early recognition of post-ERCP pancreatitis.

Methodology: Seventy-eight consecutive patients undergoing ERCP were prospectively studied. The serum concentrations of tumor necrosis factor alpha, interleukin-1beta, interleukin-6, interleukin-8, and interleukin-10 were determined immediately prior to and 1, 4, 8, and 24 hours after ERCP.

Results: Seven of 78 patients (9.0%) developed post-ERCP pancreatitis. Serum levels of tumor necrosis factor alpha, interleukin-1beta, interleukin-6, interleukin-8, and interleukin-10 significantly increased at 8 and 24 hours but not at 1 and 4 hours after ERCP in patients with post-ERCP pancreatitis, in comparison with patients without pancreatitis. Using a cutoff level of 36 pg/mL for interleukin-6 at 8 hours after ERCP, we found that the sensitivity and specificity for recognition of post-ERCP pancreatitis were 100% and 87%, respectively. Serum levels of interleukin-6 and interleukin-8 modestly increased from baseline values, 1 to 24 hours after uncomplicated ERCP.

Conclusion: Proinflammatory and antiinflammatory cytokines significantly increased in the early stage after ERCP-induced pancreatitis. Among the inflammatory cytokines, interleukin-6 is the most useful for recognition of post-ERCP pancreatitis.