Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure physicians use to examine the pancreatic or bile ducts utilizing a combination of endoscopy and fluoroscopy to capture X-ray images of the ducts. Unfortunately, this procedure is not without risks.
After undergoing ERCP, patients are typically observed for one hour before discharge. Post-ERCP pancreatitis, the most common adverse complication, can occur after discharge.
Thiruvengadam Muniraj, MD, FACG, FRCP, associate professor of medicine (digestive diseases), Yale School of Medicine, and director, Center for Advanced Endoscopy at Yale New Haven Hospital, and his colleagues employ various techniques to mitigate this risk, such as using rectal non-steroid anti-inflammatory drugs (NSAIDs), placing pancreatic duct stents, and administering aggressive fluids.
Despite the adoption of several such preventive strategies, the incidence of pancreatic inflammation after an ERCP remains substantial. On average, the incidence rate is 5-10%. For patients classified as high-risk, the likelihood increases to 25%, and the condition can be severe in rare cases. Identifying patients likely to develop pancreatitis post-ERCP is essential because they can benefit from overnight observation rather than being discharged.
A new Yale-led study, “Clinical Predictive Value of Renalase in Post-ERCP Pancreatitis,” aims to assess whether a patient's renalase level influences the development of pancreatitis following an ERCP procedure.
The findings were published in May 2024 in Gastrointestinal Endoscopy.
This research builds on prior translational and preclinical work conducted by Fred S. Gorelick, MD, Henry J. and Joan W. Binder Professor of Medicine (Digestive Diseases) and of Cell Biology; Gary V. Désir, MD, Paul B. Beeson Professor of Medicine; and Loren Laine, MD, professor of medicine (digestive diseases).
Patients with an ERCP procedure at Yale New Haven Hospital were enrolled in the trial between June 2019 and March 2022. “We plotted the renalase levels in patients who developed pancreatitis versus those who did not. Interestingly, patients who did not develop the disease exhibited higher renalase levels before the ERCP. The difference is quite striking,” continued Muniraj.
Out of 273 patients, 31 developed post-ERCP pancreatitis. Only 1 of these 31 patients had a high renalase level initially. Patients with lower renalase levels had a 12.8% rate of pancreatic inflammation, indicating that lower renalase levels pre-procedure significantly increase the risk of developing this complication. The test correctly identified 97% of the patients who developed the condition.
"This raises the question of whether renalase is simply a predictive tool or whether it can be used to prevent and treat post-ERCP pancreatitis. Further research is already underway," said Muniraj.
In addition to Muniraj, Gorelick, Désir, and Laine, other authors include Xiaojia Guo, MD; Maria M. Ciarleglio, MD; Yanhon Deng, MPH; Priya A. Jamidar, MBChB; James Farrell, MBChB; and Harry R. Aslanian, MD.
The Department of Internal Medicine at Yale School of Medicine is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators, educators, and staff in one of the world's top medical schools. To learn more, visit Internal Medicine.