Split-dose or hybrid nonsteroidal anti-inflammatory drugs and Nacetylcysteine therapy for prevention of post-retrograde cholangiopancreatography pancreatitis

作     者：Laura Pavel Gheorghe Gh Balan Alexandra Nicorescu Georgiana Emmanuela Gilca-Blanariu Catalin Sfarti Stefan Chiriac Smaranda Diaconescu Vasile Liviu Drug Gheorghe Balan Gabriela Stefanescu 

作者机构：Gastroenterology "Grigore T.Popa" University of Medicine and Pharmacy Endocrinology "Grigore T. Popa" University of Medicine and Pharmacy Department of Mother and Child Medicine "Grigore T. Popa" University of Medicine and Pharmacy 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2019年第7卷第3期

页      面：300-310页

核心收录：

学科分类：10[医学] 

主　　题：Endoscopic retrograde cholangiopancreatography Prophylaxis Postendoscopic retrograde cholangiopancreatography pancreatitis Nonsteroidal antiinflammatory drugs N-acetylcysteine 

摘      要：BACKGROUND Despite significant technical and training improvements, the incidence of postendoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) has not significantly dropped. Although many studies have evaluated the efficacy of various agents, e.g. nonsteroidal anti-inflammatory drugs, octreotide,antioxidants, administered via various dosages, routes(oral, intrarectal or parenteral), and schedules(before or after the procedure), the results have been *** To evaluate efficacy of three pharmacologic prophylactic methods for prevention of *** In this prospective, single-center randomized trial, patients who underwent firsttime ERCP for choledocholithiasis were randomly assigned to three groups. The first group received 600 mg N-acetylcysteine 15 min prior to ERCP, and perrectum administration of 50 mg indomethacin both prior to and after completion of the ERCP. The second group was administered only the 50 mg indomethacin per-rectum both prior to and after the ERCP. The third group was administeredper-rectum 100 mg indomethacin only after the ERCP, representing the control group given the guideline-recommended regimen. The primary end-point was PEP *** Among the total 211 patients evaluated during the study, 186 fulfilled the inclusion criteria and completed the protocol. The percentages of patients who developed PEP in each of the three groups were not significantly different(χ2 =2.793, P = 0.247). Among the acute PEP cases, for all groups, 14 patients developed mild pancreatitis(77.77%) and 4 moderate. No severe cases of PEP occurred, and in all PEP cases the resolution was favorable. No adverse events related to the medications(digestive hemorrhage, rectal irritation, or allergies)*** The efficacies of split-dose indomethacin and combined administration(Nacetylcysteine with indomethacin) for preventing PEP were similar to that of the standard regimen.