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ACUTE PANCREATITIS FOLLOWING ROUTINE ESOPHAGOGASTRODUODENOSCOPY: A CASE REPORT AND LITERATURE REVIEW.
Abdul-rahman I. Abusalim
*1, Essam Rashad
2, Mohammad N. Kloub
3, Mohamed Eldesouki
3, Ziad Sad Aldeen
11Hospital Medicine, University of Wisconsin-Madison, Madison, WI; 2Parkview Health, Fort Wayne, IN; 3Saint Michael's Medical Center, Newark, NJ
Background: Acute pancreatitis following routine esophagogastroduodenoscopy (EGD) is extremely rare, with only a small number of documented cases in the literature. While pancreatitis is a well-known complication of endoscopic retrograde cholangiopancreatography (ERCP), its occurrence after diagnostic or therapeutic EGD without ductal or ampullary manipulation is unexpected.
Case Presentation: A 42-year-old male with Lynch syndrome underwent routine surveillance EGD with a duodenal biopsy. Six hours post-procedure, he developed severe epigastric pain radiating to his back, accompanied by nausea. Laboratory investigations revealed elevated lipase levels, and imaging confirmed acute interstitial pancreatitis (Figure 1). The patient remained hemodynamically stable and was managed conservatively with IV fluids, bowel rest, and pain control, achieving full recovery within 4 days.
Methods: We conducted a systematic review of the literature using the PubMed and Google Scholar databases, supplemented by manual reference checking of the included articles.
Results: We identified 13 published cases from 1982 to 2024, with the 14th case being our own. Analysis revealed that the onset of symptoms most commonly occurred within 6 hours post-procedure, with a mean onset of 4 hours. The distribution of cases was equal between males and females. A higher risk was associated with duodenal interventions during EGD, including endoscopic mucosal resection (EMR) and duodenal biopsies, with endoscopic insufflation suggested as one of the triggers. Clinical outcomes were variable, ranging from brief hospitalizations (with an average length of stay of 13 days) and full recovery to death.
Conclusion: While rare, post-EGD pancreatitis should be considered in patients presenting with abdominal pain following the procedure, particularly after duodenal interventions. Early recognition and appropriate management are crucial for achieving optimal outcomes.
Figure 1
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