1
|
Alavinejad P, Tran NPN, Eslami O, Shaarawy OE, Hormati A, Seiedian SS, Parsi A, Ahmed MH, Behl NS, Abravesh AA, Tran QT, Vignesh S, Salman S, Sakr N, Ara TF, Hajiani E, Hashemi SJ, Patai ÁV, Butt AS, Lee SH. ORAL N-ACETYL CYSTEINE VERSUS RECTAL INDOMETHACIN FOR PREVENTION OF POST ERCP PANCREATITIS: A MULTICENTER MULTINATIONAL RANDOMIZED CONTROLLED TRIAL. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:508-512. [PMID: 36383882 DOI: 10.1590/s0004-2803.202204000-90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND This multicenter multinational RCT designed to compare the efficacy of suppository indomethacin and NAC for prevention of PEP. METHODS During a 6-month period, all of the ERCP cases in seven referral centers were randomly assigned to receive either 1200 mg oral NAC, indomethacin suppository 100 mg, 1200 mg oral NAC plus indomethacin suppository 100 mg or placebo 2 hours before ERCP. The primary outcomes were the rate and severity of any PEP. RESULTS A total of 432 patients included (41.4% male). They were originally citizens of 6 countries (60.87% Caucasian). They were randomly allocated to receive either NAC (group A, 84 cases), rectal indomethacin (group B, 138 cases), NAC + rectal indomethacin (group C, 115 cases) or placebo (group D, 95 cases). The rate of PEP in groups A, B and C in comparison with placebo were 10.7%, 17.4%, 7.8% vs 20% (P=0.08, 0.614 & 0.01 respectively). The NNT for NAC, indomethacin and NAC + indomethacin was 11, 38 and 8 respectively. CONCLUSION Oral NAC is more effective than rectal indomethacin when compared to placebo for prevention of PEP and the combination of NAC and Indomethacin had the lowest incidence of PEP and may have synergistic effect in preventing of PEP (IRCT20201222049798N1; 29/12/2020).
Collapse
Affiliation(s)
- Pezhman Alavinejad
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
- World Endoscopy Organization emerging star group, WEO, Munich, Germany
| | | | - Omid Eslami
- Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Omar El Shaarawy
- Lecturer and consultant of Hepatology, Gastroenterology and Endoscopy, National Liver institute, Menoufia University, Egypt
| | - Ahmad Hormati
- Gastrointestinal and liver Diseases Research Center, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seied Saeed Seiedian
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Abazar Parsi
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Mohammed Hussien Ahmed
- Lecturer Hepatology Gastroenterology and infectious diseases, Faculty of Medicine, Kafrelsheikh University, Cairo, Egypt
| | - Nitin Shanker Behl
- Institute of Gastro and Liver diseases, Fortis Hospital, Ludhiana, India
| | - Ali Akbar Abravesh
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Quang Trung Tran
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Vietnam
- Department of Internal Medicine A, University Medicine Greifswald, Germany
- World Endoscopy Organization emerging star group, WEO, Munich, Germany
| | - Shivakumar Vignesh
- Division of gastroenterology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
- World Endoscopy Organization emerging star group, WEO, Munich, Germany
| | - Saif Salman
- Hashemite University, Faculty of Medicine, Alzarqa, Jordan
| | - Naemt Sakr
- Assistant Lecturer and specialist of Hepatology and Gastroenterology at the National Liver Institute, Menoufia University, Egypt
| | - Tahmineh Farbod Ara
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Eskandar Hajiani
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Seyed Jalal Hashemi
- Alimentary Tract Research Center, Imam Khomeini hospital clinical research development Unit, The school of medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Árpád V Patai
- Gastroenterology Division, Internal Medicine and Hematology Department, Semmelweis University, Budapest, Hungary
- Interdisciplinary Gastroenterology Working Group, Semmelweis University, Budapest, Hungary
| | - Amna Subhan Butt
- World Endoscopy Organization emerging star group, WEO, Munich, Germany
- Consultant Gastroenterologist, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan
| | - Sang Hyub Lee
- World Endoscopy Organization emerging star group, WEO, Munich, Germany
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|