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Post ERCP Changes in Oxidative Stress as a Possible Cause of Pancreatitis

Moshe Shiller, Dmetry Iarovinsky, Dikla Dror-Tzur, Anas Kadah, Wisam Sbeit

Oxidative Stress is caused by imbalance between the oxidative and anti-oxidative systems. Excessive production of reactive oxygen species has a recognized role in the pathophysiology of acute pancreatitis in the animal model. Pancreatitis is the most common unplanned event resulting from ERCP, with an incidence of about 2-9% of procedures. Aim of the study To examine whether ERCP causes oxidative stress, and to examine whether pre-procedure elevation of laboratory indicators of oxidative stress can predict pancreatitis following ERCP. Materials and methods A prospective study that was carried out over 6 months in 40 patients. We obtained markers of oxidative stress prior to ERCP, 24 and 48 hours postprocedure (MDA, AOPP- Advanced oxidation protein products, glutathione, inflammation markers (CRP, fibrinogen)). In addition, we measured serum amylase levels with the same timing. Results Five patients developed post-procedure pancreatitis, Ranson <3. Mean levels of markers for oxidative stress AOPP, MDA and levels of fibrinogen preprocedure were very elevated for the study population; these levels decreased in the first 24 hours, but not to normal levels. There was a marked reduction in glutathione levels after 24 hours. There was no difference in the pre- or post-procedure levels of fibrinogen, CRP, MDA or AOPP between the pancreatitis and non-pancreatitis groups. Patients with glutathione >2 micromol/liter before the procedure did not develop pancreatitis. Conclusion Most patients showed high oxidative stress prior to ERCP. The parameters of oxidative stress that we examined were not elevated following the procedure. With regard to the decrease observed in glutathione levels, we can infer indirectly that there was some increase in oxidative stress following the procedure.