N-acetylcysteine does not prevent post-endoscopic retrograde cholangiopancreatography hyperamylasemia and acute pancreatitis

Milewski, Janusz; Rydzewska, Grażyna; Degowska, Małgorzata; Kierzkiewicz, Maciej; Rydzewski, Andrzej

doi:10.3748/wjg.v12.i23.3751

Cited by 39 publications

(28 citation statements)

References 40 publications

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“…N-acetylcysteine a free radical scavenger inhibits capillary endothelial injury mediated by oxygen-derived free radicals. Two recent studies from Poland and Greece concluded that N-acetylcysteine failed to demonstrate any significant preventive effect on PEP, nor asymptomatic serum or urine amylase elevations [113,114] . An inhibitor of the platelet activating factor diminished experimental acute pancreatitis.…”

Section: Category 3: Markers Of Systemic Inflammationmentioning

confidence: 99%

Pancreatits after endoscopic retrograde cholangio-pancreatography

Aziz

Lehman

2007

WJG

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Pancreatitis is the most common complication after endoscopic retrograde cholangio-pancreatography (ERCP); the reported incidence of this complication varies from less than 1% to 40%, but a rate of 4%-8% is reported in most prospective studies involving nonselected patients. Differences in criteria for defining pancreatitis, methods of data collection, and patient populations (i.e. number of high-risk patients included in the published series) are factors that are likely to affect the varying rates of post-ERCP pancreatitis. The severity of post-ERCP pancreatitis (PEP) can range from a minor inconvenience with one or two days of added hospitalization with full recovery to a devastating illness with pancreatic necrosis, multiorgan failure, permanent disability, and even death. Although, most episodes of PEP are mild (about 90%), a small percentage of patients (about 10%) develop moderate or severe pancreatitis. In the past, PEP was often viewed as an unpredictable and unavoidable complication, with no realistic strategy for its avoidance. New data have aided in stratification of patients into PEP risk categories and new measures have been introduced to decrease the risk of PEP. As most ERCPs are performed on an outpatient basis, the majority of patients will not develop PEP and can be discharged. Alternatively, early detection of those patients who will go on to develop PEP can guide decisions regarding hospital admission and aggressive management. In the last decade, great efforts have been addressed toward prevention of this complication. Points of emphasis have included technical measures, pharmacological prophylaxis, and patient selection. This review provides a comprehensive, evidence-based assessment of published data on PEP and current suggestions for its avoidance.© 2007 The WJG Press. All rights reserved.Key words: Endoscopic retrograde cholangiopancreatography; Post-ERCP pancreatitis Abdel Aziz AM, Lehman GA. Pacreatitis after endoscopic r e t r o g r a d e c h o l a n g i o -p a n c r e a t o g r a p h y . W o r l d J

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Section: Category 3: Markers Of Systemic Inflammationmentioning

confidence: 99%

Pancreatits after endoscopic retrograde cholangio-pancreatography

Aziz

Lehman

2007

WJG

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“…Amongst the 22 papers, 19 (86%) scored 3 and only three studies [17,25,31] scored 2 or lower according to the Jadad score. Table 1 presents controlled clinical trials of antioxidants in patients with AP or CP.…”

Section: Resultsmentioning

confidence: 99%

“…Their results showed that the rate of PEP was not significantly reduced. In addition, urine amylase activity, total bilirubin, alanine, aspartate aminotransferases and white blood cells showed no change [31] . In the other double-blind, placebo-controlled trial (n = 256), patients received intravenous NAC at a loading dose of 70 mg/kg 2 h before and 35 mg/kg at 4-h intervals for a total of 24 h after the procedure.…”

Section: Antioxidants In Pepmentioning

confidence: 91%

“…In four studies [17,18,22,23] glutamine was supplemented to standard total parenteral nutrition (TPN) in AP patients. In one randomized controlled study (n = 28), glutamine was used in AP in combination with standard TPN and demonstrated a decrease in the duration of TPN therapy and hospitalization without a change in the total www.wjgnet.com Xue et al [17] [18] 2008 Uden et al [28,29] In the non-high-risk group (n = 520), the crude PEP rates were 5.4% for allopurinol and 1.5% for placebo (P = 0.017), favoring placebo, indicating harm associated with allopurinol, whereas in the high-risk group (n = 66), the PEP rates were 6.3% for allopurinol and 23.5% for placebo (P = 0.050), favoring allopurinol Milewski et al [31] 2006 N-acetylcysteine [35] 2004 Natural β-carotene …”

Section: Antioxidants In Ap and Cpmentioning

confidence: 98%

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Antioxidant therapy in the management of acute, chronic and post-ERCP pancreatitis: A systematic review

Monfared¹,

Vahidi²,

Abdolghaffari³

et al. 2009

WJG

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We systematically reviewed the clinical trials which recruited antioxidants in the therapy of pancreatitis and evaluated whether antioxidants improve the outcome of patients with pancreatitis. Electronic bibliographic databases were searched for any studies which investigated the use of antioxidants in the management of acute pancreatitis (AP) or chronic pancreatitis (CP) and in the prevention of post-endoscopic retrograde cholangio-pancreatography (post-ERCP) pancreatitis (PEP) up to February 2009. Twenty-two randomized, placebo-controlled, clinical trials met our criteria and were included in the review. Except for a cocktail of antioxidants which showed improvement in outcomes in three different clinical trials, the results of the administration of other antioxidants in both AP and CP clinical trials were incongruent and heterogeneous.Furthermore, antioxidant therapy including allopurinol and N-acetylcysteine failed to prevent the onset of PEP in almost all trials. In conclusion, the present data do not support a benefit of antioxidant therapy alone or in combination with conventional therapy in the management of AP, CP or PEP. Further double blind, randomized, placebo-controlled clinical trials with large sample size need to be conducted.

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“…N-acetyl cysteine is a free radical cleaner stimulating glutathione synthesis. It was used as IV before and after ERCP in two randomized controlled trials and was not found superior to placebo in the prevention of PEP and hyperamylasemia (125,126).…”

Section: Drugs Reducing Inflammationmentioning

confidence: 99%