Pharmacological prevention of post-operative pancreatitis: systematic review and meta-analysis of randomized controlled trials on animal studies
Corresponding Author
Jack Cecire MBBS
Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
Correspondence
Dr Jack Cecire, Surgical Innovations Unit, Westmead Hospital, Sydney, NSW, Australia.
Email: [email protected]
Contribution: Conceptualization, Data curation, Formal analysis, Visualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorKristian Adams BSc, MD
Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
Contribution: Conceptualization, Data curation, Formal analysis, Writing - original draft
Search for more papers by this authorHelen Pham MBBS, FRACS
Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
Western Clinical School, Faculty of Medical and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
Department of Hepatobiliary, Pancreatic/Upper Gastrointestinal Surgery, Westmead Hospital, Sydney, New South Wales, Australia
Contribution: Conceptualization, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorTony Pang BSC(MED), MBBS(HONS), MBIOSTAT, MS, FRACS, ANZHPBA
Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
Western Clinical School, Faculty of Medical and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
Department of Hepatobiliary, Pancreatic/Upper Gastrointestinal Surgery, Westmead Hospital, Sydney, New South Wales, Australia
Contribution: Conceptualization, Formal analysis, Supervision, Writing - original draft
Search for more papers by this authorDavid Burnett BSC(MED), MBBS, FRACS, ANZHPBA
Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
Contribution: Conceptualization, Methodology, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorCorresponding Author
Jack Cecire MBBS
Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
Correspondence
Dr Jack Cecire, Surgical Innovations Unit, Westmead Hospital, Sydney, NSW, Australia.
Email: [email protected]
Contribution: Conceptualization, Data curation, Formal analysis, Visualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorKristian Adams BSc, MD
Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
Contribution: Conceptualization, Data curation, Formal analysis, Writing - original draft
Search for more papers by this authorHelen Pham MBBS, FRACS
Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
Western Clinical School, Faculty of Medical and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
Department of Hepatobiliary, Pancreatic/Upper Gastrointestinal Surgery, Westmead Hospital, Sydney, New South Wales, Australia
Contribution: Conceptualization, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorTony Pang BSC(MED), MBBS(HONS), MBIOSTAT, MS, FRACS, ANZHPBA
Surgical Innovations Unit, Westmead Hospital, Sydney, New South Wales, Australia
Western Clinical School, Faculty of Medical and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
Department of Hepatobiliary, Pancreatic/Upper Gastrointestinal Surgery, Westmead Hospital, Sydney, New South Wales, Australia
Contribution: Conceptualization, Formal analysis, Supervision, Writing - original draft
Search for more papers by this authorDavid Burnett BSC(MED), MBBS, FRACS, ANZHPBA
Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
Contribution: Conceptualization, Methodology, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorAbstract
Background
Postoperative pancreatic fistula (POPF) remains a significant complication of pancreatic resection with recent evidence showing a strong association between post-operative pancreatitis and subsequent development of POPF. Incidence and severity of pancreatitis following endoscopic therapy has been effectively reduced with indomethacin prophylaxis, however further agents require evaluation. We present a systematic literature review and meta-analysis of the prophylactic treatment with corticosteroids or n-acetyl cysteine (NAC) of induced pancreatitis in rodent models.
Methods
A systematic literature search was conducted using Pubmed, Medline, Embase and Cochrane library to identify eligible randomized control trials (RCT) involving animal models that examined NAC or corticosteroids. The primary outcome was the subsequent effect on serum amylase and IL-6 and the histopathological markers of severity such as pancreatic oedema and necrosis.
Results
Four RCTs (n = 178) met inclusion criteria examining NAC and eight RCTs (n = 546) examining corticosteroid agents (dexamethasone, hydrocortisone, methylprednisolone). Prophylactic administration of all corticosteroid agents showed a net effect in favour of reducing markers of severity of pancreatitis. NAC showed a significant reduction in severity of amylase and necrosis.
Conclusion
The RCTs examined suggest that prophylactic administration of corticosteroid agents and NAC can reduce the severity of pancreatitis as indicated by histopathologic markers, serum amylase and IL-6 levels.
Conflict of interest
None declared.
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