N-acetylcysteine does not prevent post-endoscopic retrograde cholangiopancreatography hyperamylasemia and acute pancreatitis.
OBJECTIVE
Acute pancreatitis (AP) is the most common and often severe complication of endoscopic retrograde cholangiopancreatography (ERCP). The early step in the pathogenesis of acute pancreatitis is probably the capillary endothelial injury mediated by oxygen-derived free radicals. N-acetylcysteine - a free radical scavenger may be potentially effective in preventing post-ERCP acute pancreatitis and it is also known that N-acetylcysteine (ACC) can reduce the severity of disease in experimental model of AP.


METHODS
One hundred and six patients were randomly allocated to two groups. Fifty-five patients were given N-acetylcysteine (two 600 mg doses orally 24 and 12 h before ERCP and 600 mg was given iv, twice a day for two days after the ERCP). The control group consisted of 51 patients who were given iv. isotonic saline twice a day for two days after the ERCP. Serum and urine amylase activities were measured before ERCP and 8 and 24 h after the procedure. The primary outcome parameter was post-ERCP acute pancreatitis and the secondary outcome parameters were differences between groups in serum and urine amylase activity.


RESULTS
There were no significant differences in the rate of post-ERCP pancreatitis between two groups (10 patients overall, 4 in the ACC group and 6 in the control group). There were also no significant differences in baseline and post-ERCP serum and urine amylase activity between ACC group and control group.


CONCLUSIONS
N-acetylcysteine fails to demonstrate any significant preventive effect on post-ERCP pancreatitis, as well as on serum and urine amylase activity.
Milewski
Janusz
J
Department of Internal Medicine and Gastroenterology, Central Clinical Hospital of Ministry of Internal Affairs, Warsaw, Poland.
Rydzewska
Grazyna
G
Degowska
Malgorzata
M
Kierzkiewicz
Maciej
M
Rydzewski
Andrzej
A
D000111:Acetylcysteine / Q000627:therapeutic use*; D000208:Acute Disease; D000681:Amylases / Q000097:blood / Q000652:urine; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004730:Endothelium, Vascular / Q000293:injuries / Q000503:physiopathology; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D005609:Free Radicals; D006801:Humans; D034321:Hyperamylasemia / Q000097:blood / Q000209:etiology* / Q000517:prevention & control* / Q000652:urine; D008297:Male; D010195:Pancreatitis / Q000097:blood / Q000209:etiology* / Q000517:prevention & control* / Q000652:urine; D012044:Regression Analysis; D012720:Severity of Illness Index; D016896:Treatment Outcome
D016166:Free Radical Scavengers; D005609:Free Radicals; D000681:Amylases; D000111:Acetylcysteine