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. 2025 Jan 19;9(1):e70083.
doi: 10.1002/jgh3.70083. eCollection 2025 Jan.

Efficacy of 2-Mercaptoethane Sulfonate Sodium (MESNA) in the Prevention of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography: A Randomized Open Label Trial

Amir Sadeghi  1 , Hesamoddin Samar  2 , Mohammad Abbasinazari  3 , Parvaneh Mohammadi  1 , Ali Abazarikia  2 , Shadi Ziaie  2
Affiliations

Efficacy of 2-Mercaptoethane Sulfonate Sodium (MESNA) in the Prevention of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography: A Randomized Open Label Trial

Amir Sadeghi et al. JGH Open. .

Abstract

Background and aim: Oxidative stress has been considered a factor in the development of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The present clinical trial evaluated whether adding intravenous mesna to rectal indomethacin could prevent or alleviate PEP.

Methods: An open-labeled clinical trial was done on 698 participants undergoing endoscopic retrograde cholangiopancreatography (ERCP). Eligible patients received 100 mg indomethacin suppository 30 min before undergoing ERCP. Randomly, the participants received 400 mg intravenous mesna or nothing 30 min before doing the procedure. The PEP incidence and degree were measured in the patients as the main outcome.

Results: The total rate of PEP was equal to 13.7%. No significant difference was seen in the rate and severity of PEP between the mesna plus indomethacin and indomethacin alone arms (14% vs. 13.4%, respectively, p = 0.671). In high-risk patients, PEP rate and severity were lower in the mesna plus indomethacin group compared with indomethacin alone group and the statistical analysis showed that the difference was significant (41.7% vs. 51.8%, respectively, p = 0.033).

Conclusion: In high-risk patients undergoing ERCP, a combination of intravenous mesna plus rectal indomethacin may decrease the PEP rate and severity.

Keywords: ERCP; Mesna; indomethacin; pancreatitis; trial.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study.
FIGURE 2
FIGURE 2
Rate and severity of pancreatitis.
FIGURE 3
FIGURE 3
PEP incidence and severity in high‐risk patients of two arms.
See this image and copyright information in PMC

References

    1. Huang Y. and Badurdeen D. S., “Acute Pancreatitis Review,” Turkish Journal of Gastroenterology 34 (2023): 795–801. - PMC - PubMed
    1. Forsmark C. E., Vege S. S., and Wilcox C. M., “Acute Pancreatitis,” New England Journal of Medicine 17, no. 375 (2016): 1972–1981. - PubMed
    1. Dumonceau J. M., Kapral C., Aabakken L., et al., “ERCP‐Related Adverse Events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline,” Endoscopy 52 (2020): 127–149. - PubMed
    1. Cahyadi O., Tehami N., De‐Madaria E., and Siau K., “Post‐ERCP Pancreatitis: Prevention, Diagnosis and Management,” Medicina (Kaunas, Lithuania) 12, no. 58 (2022): 1261. - PMC - PubMed
    1. Mohammad Alizadeh A. H., Abbasinazari M., Hatami B., et al., “Comparison of Rectal Indomethacin, Diclofenac, and Naproxen for the Prevention of Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis,” European Journal of Gastroenterology & Hepatology 29 (2017): 349–354. - PubMed

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