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World J Gastroenterol. Jun 21, 2006; 12(23): 3751-3755
Published online Jun 21, 2006. doi: 10.3748/wjg.v12.i23.3751
N-acetylcysteine does not prevent post-endoscopic retrograde cholangiopancreatography hyperamylasemia and acute pancreatitis
Janusz Milewski, Grazyna Rydzewska, Malgorzata Degowska, Maciej Kierzkiewicz, Andrzej Rydzewski
Janusz Milewski, Malgorzata Degowska, Maciej Kierzkiewicz, Department of Internal Medicine and Gastroenterology, Central Clinical Hospital of Ministry of Internal Affairs and Administration, Warsaw, Poland
Grazyna Rydzewska, Department of Internal Medicine and Gastroenterology, Central Clinical Hospital of Ministry of Internal Affairs and Administration, Warsaw, and Institute of Experimental and Clinical Medicine, Polish Academy of Sciences, Warsaw, Poland
Andrzej Rydzewski, Department of Internal Medicine & Nephrology, Central Clinical Hospital of Ministry of Internal Affairs and Administration, Warsaw, and Institute of of Experimental and Clinical Medicine, Polish Academy of Sciences, Warsaw, Poland
Correspondence to: Professor Grazyna Rydzewska MD, PhD, Department of Internal Medicine and Gastroenterology, Central Clinical Hospital of Ministry of Internal Affairs, Woloska str. 137, 02- 507 Warsaw, Poland. grazyna.rydzewska@cskmswia.pl
Telephone: +48-22-6021240 Fax: +48-22-8451468
Received: November 14, 2005
Revised: November 28, 2005
Accepted: December 12, 2005
Published online: June 21, 2006
Abstract

AIM: 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.

CONCLUSION: N-acetylcysteine fails to demonstrate any significant preventive effect on post-ERCP pancreatitis, as well as on serum and urine amylase activity.

Keywords: N-acetylcysteine; ERCP; Acute pancreatitis; Hyperamylasemia