Background and study aims: Pancreatitis complicates 1 % - 22 % of endoscopic retrograde cholangiopancreatography
procedures. The study aims were to develop a reproducible animal model of post-ERCP
pancreatitis (PEP), and investigate the impact of endoscopic technique on severity
of PEP.
Patients and methods: ERCP was carried out in six male hound dogs. Pancreatitis was induced by one
of three escalating methods: 1) pancreatic acinarization with 20 - 30 mL of
contrast; 2) acinarization + ductal balloon occlusion + sphincterotomy; 3) acinarization
+ intraductal synthetic bile injection + ductal balloon occlusion + sphincterotomy.
Dogs 5 and 6 received a pancreatic stent. Necropsy was performed on postoperative
day 5. All pancreatic specimens were graded by two blinded pathologists according
to a validated scoring system. All dogs were compared with three control dogs.
Results: Dogs 1 - 4 developed clinical pancreatitis and hyperamylasemia (11 736 vs. 722
U/L, P = 0.02). Total injury scores were significantly elevated compared with controls
(6.85 vs. 1.06, P = 0.004). There was significant increase in acinar cell necrosis (0.86 vs. 0.06,
P = < 0.001), and all other categories (except fibrosis) demonstrated elevated injury
scores. Dogs 5 and 6 developed clinical pancreatitis without significant hyperamylasemia;
total injury scores were elevated compared with controls (4.83 vs. 1.06, P = 0.01), but lower than in Dogs 1 - 4 (4.83 vs. 6.85, P = 0.25). There was escalating severity of pancreatic injury from Dogs 1 to 4 correlating
with the method of endoscopic injury used.
Conclusion: Severity of PEP is directly proportional to invasiveness of endoscopic intervention.
Pancreatic acinarization, even without balloon occlusion and sphincterotomy, can
be used as a reliable animal model for future studies investigating therapy and
prevention of disease.
References
The digestive apparatus and abdomen. In: Miller’s anatomy of the dog. 2nd edn. Philadelphia; Saunders 1983: 456-460
jbuscaglia@jhmi.edu
