{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:43:23Z","timestamp":1791614603049,"version":"4.3.4"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"DOI":"10.1186\/s12876-025-04382-0","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T10:51:30Z","timestamp":1762253490000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy of N-Acetylcysteine in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"25","author":[{"given":"Ahmad","family":"Hormati","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma","family":"Mousavi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shayan","family":"Shojaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atie","family":"Moghtadaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanaz","family":"Bordbar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hediyeh","family":"Alemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Kasaeian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadaf","family":"Sepanlou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"key":"4382_CR1","volume":"12","author":"A Sharma","year":"2020","unstructured":"Sharma A, Rakholiya JH, Madapu A, Sharma S, Jha A. Trend and predictors of the utilization of endoscopic retrograde cholangiopancreatography in acute pancreatitis hospitalizations. Cureus. 2020;12:e11420.","journal-title":"Cureus"},{"key":"4382_CR2","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1016\/j.giec.2012.05.001","volume":"22","author":"ML Freeman","year":"2012","unstructured":"Freeman ML. Complications of endoscopic retrograde cholangiopancreatography: avoidance and management. Gastrointest Endosc Clin N Am. 2012;22:567\u201386.","journal-title":"Gastrointest Endosc Clin N Am"},{"key":"4382_CR3","first-page":"65","volume":"27","author":"P Katsinelos","year":"2014","unstructured":"Katsinelos P, Lazaraki G, Chatzimavroudis G, Gkagkalis S, Vasiliadis I, Papaeuthimiou A, et al. Risk factors for therapeutic ERCP-related complications: an analysis of 2,715 cases performed by a single endoscopist. Ann Gastroenterol. 2014;27:65\u201372.","journal-title":"Ann Gastroenterol"},{"key":"4382_CR4","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.3390\/medicina58091261","volume":"58","author":"O Cahyadi","year":"2022","unstructured":"Cahyadi O, Tehami N, de-Madaria E, Siau K. Post-ERCP pancreatitis: prevention, diagnosis and management. Medicina (Kaunas). 2022;58:1261\u201375. https:\/\/doi.org\/10.3390\/medicina58091261.","journal-title":"Medicina (Kaunas)"},{"key":"4382_CR5","doi-asserted-by":"publisher","DOI":"10.4103\/jrms.jrms_150_22","volume":"28","author":"A Shavakhi","year":"2023","unstructured":"Shavakhi A, Zobeiri M, Khodadoostan M, Zobeiri MJ, Shavakhi A. Risk factors for ERCP-related complications and what is the specific role of ASGE grading system. J Res Med Sci. 2023;28:7.","journal-title":"J Res Med Sci"},{"key":"4382_CR6","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1055\/a-1075-4080","volume":"52","author":"J-M Dumonceau","year":"2020","unstructured":"Dumonceau J-M, Kapral C, Aabakken L, Papanikolaou IS, Tringali A, Vanbiervliet G, et al. ERCP-related adverse events: European society of gastrointestinal endoscopy (ESGE) guideline. Endoscopy. 2020;52:127\u201349.","journal-title":"Endoscopy"},{"key":"4382_CR7","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.gie.2022.10.005","volume":"97","author":"JL Buxbaum","year":"2023","unstructured":"Buxbaum JL, Freeman M, Amateau SK, Chalhoub JM, Coelho-Prabhu N, Desai M, et al. American society for gastrointestinal endoscopy guideline on post-ERCP pancreatitis prevention strategies: summary and recommendations. Gastrointest Endosc. 2023;97:153\u201362.","journal-title":"Gastrointest Endosc"},{"key":"4382_CR8","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1055\/a-1220-2242","volume":"53","author":"HR Mutneja","year":"2021","unstructured":"Mutneja HR, Vohra I, Go A, Bhurwal A, Katiyar V, Tejeda EP, et al. Temporal trends and mortality of post-ERCP pancreatitis in the United States: a nationwide analysis. Endoscopy. 2021;53:357\u201366.","journal-title":"Endoscopy"},{"key":"4382_CR9","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1093\/gastro\/gou083","volume":"3","author":"AM Thaker","year":"2015","unstructured":"Thaker AM, Mosko JD, Berzin TM. Post-endoscopic retrograde cholangiopancreatography pancreatitis. Gastroenterol Rep. 2015;3:32\u201340.","journal-title":"Gastroenterol Rep"},{"key":"4382_CR10","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1177\/2050640619834839","volume":"7","author":"XJ Smeets","year":"2019","unstructured":"Smeets XJ, Bouhouch N, Buxbaum J, Zhang H, Cho J, Verdonk R, et al. The revised Atlanta criteria more accurately reflect severity of post-ERCP pancreatitis compared to the consensus criteria. United Eur Gastroenterol J. 2019;7:557\u201364.","journal-title":"United Eur Gastroenterol J"},{"key":"4382_CR11","doi-asserted-by":"publisher","first-page":"2380","DOI":"10.1007\/s11605-022-05399-6","volume":"26","author":"X Kang","year":"2022","unstructured":"Kang X, Guo X, Chen Z, Zhou Z, Luo H, Lu Y, et al. The incidence and severity of post-ERCP pancreatitis in patients receiving standard administration of NSAIDs: a systematic review and meta-analysis. J Gastrointest Surg. 2022;26:2380\u20139.","journal-title":"J Gastrointest Surg"},{"key":"4382_CR12","doi-asserted-by":"publisher","first-page":"469","DOI":"10.4253\/wjge.v12.i11.469","volume":"12","author":"JPR Serrano","year":"2020","unstructured":"Serrano JPR, Jukemura J, Romanini SG, Aguilar PFG, de Castro JSL, Torres IT, et al. Nonsteroidal anti-inflammatory drug effectivity in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis. World J Gastrointest Endosc. 2020;12:469\u201387.","journal-title":"World J Gastrointest Endosc"},{"key":"4382_CR13","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1016\/j.pan.2021.04.006","volume":"21","author":"Z Dubravcsik","year":"2021","unstructured":"Dubravcsik Z, Hritz I, Keczer B, Nov\u00e1k P, Lov\u00e1sz BD, Mad\u00e1csy L. Network meta-analysis of prophylactic pancreatic stents and non-steroidal anti-inflammatory drugs in the prevention of moderate-to-severe post-ERCP pancreatitis. Pancreatology. 2021;21:704\u201313.","journal-title":"Pancreatology"},{"key":"4382_CR14","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.cgh.2016.06.007","volume":"15","author":"JH Choi","year":"2017","unstructured":"Choi JH, Kim HJ, Lee BU, Kim TH, Song IH. Vigorous periprocedural hydration with lactated ringer\u2019s solution reduces the risk of pancreatitis after retrograde cholangiopancreatography in hospitalized patients. Clin Gastroenterol Hepatol. 2017;15:86-92.e81.","journal-title":"Clin Gastroenterol Hepatol"},{"key":"4382_CR15","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1055\/s-0043-122386","volume":"50","author":"CH Park","year":"2018","unstructured":"Park CH, Paik WH, Park ET, Shim CS, Lee TY, Kang C, et al. Aggressive intravenous hydration with lactated Ringer\u2019s solution for prevention of post-ERCP pancreatitis: a prospective randomized multicenter clinical trial. Endoscopy. 2018;50:378\u201385.","journal-title":"Endoscopy"},{"key":"4382_CR16","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1080\/17474124.2024.2345640","volume":"18","author":"EJ Rojas-Victoria","year":"2024","unstructured":"Rojas-Victoria EJ, Hern\u00e1ndez-Ruiz SI, Garc\u00eda-Perdomo HA. Effectiveness of the pharmacological therapy to prevent post ERCP acute pancreatitis: a network meta-analysis. Expert Rev Gastroenterol Hepatol. 2024;18:203\u201315.","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"4382_CR17","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/j.jss.2016.03.004","volume":"203","author":"S Turkyilmaz","year":"2016","unstructured":"Turkyilmaz S, Usta A, Cekic AB, Alhan E, Kural BV, Ercin C. N-acetylcysteine amid reduces pancreatic damage in a rat model of acute necrotizing pancreatitis. J Surg Res. 2016;203:383\u20139.","journal-title":"J Surg Res"},{"key":"4382_CR18","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1080\/08941939.2016.1230247","volume":"30","author":"S Zeren","year":"2017","unstructured":"Zeren S, Bayhan Z, Ko\u00e7ak C, Ko\u00e7ak FE, Metineren MH, Savran B, et al. Antioxidant effect of Ukrain versus N-acetylcysteine against acute biliary pancreatitis in an experimental rat model. J Invest Surg. 2017;30:116\u201324.","journal-title":"J Invest Surg"},{"key":"4382_CR19","doi-asserted-by":"publisher","first-page":"6745","DOI":"10.3748\/wjg.v21.i21.6745","volume":"21","author":"C Fuentes-Orozco","year":"2015","unstructured":"Fuentes-Orozco C, D\u00e1valos-Cobi\u00e1n C, Garc\u00eda-Correa J, Ambriz-Gonz\u00e1lez G, Mac\u00edas-Amezcua MD, Garc\u00eda-Renter\u00eda J, et al. Antioxidant drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis: What does evidence suggest? World J Gastroenterol. 2015;21:6745\u201353.","journal-title":"World J Gastroenterol"},{"key":"4382_CR20","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1590\/s0004-2803.202204000-90","volume":"59","author":"P Alavinejad","year":"2022","unstructured":"Alavinejad P, Tran NN, Eslami O, Shaarawy OE, Hormati A, Seiedian SS, et al. Oral n-acetyl cysteine versus rectal indomethacin for prevention of post ercp pancreatitis: a multicenter multinational randomized controlled trial. Arq Gastroenterol. 2022;59:508\u201312.","journal-title":"Arq Gastroenterol"},{"key":"4382_CR21","first-page":"17","volume":"5","author":"P Alavi Nejad","year":"2013","unstructured":"Alavi Nejad P, Hajiani E, Hashemi J, Masjedizadeh AR, Shayesteh AA, Sebghatollahi V. Evaluation of N-acetyl cysteine for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a prospective double blind randomized pilot study. Middle East J Dig Dis. 2013;5:17\u201321.","journal-title":"Middle East J Dig Dis"},{"key":"4382_CR22","volume":"3","author":"D Moher","year":"2009","unstructured":"Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Open Med. 2009;3:e123-130.","journal-title":"Open Med"},{"key":"4382_CR23","first-page":"l4898","volume":"366","author":"JAC Sterne","year":"2019","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed). 2019;366:l4898.","journal-title":"BMJ (Clinical research ed)"},{"key":"4382_CR24","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.cct.2015.09.002","volume":"45","author":"R DerSimonian","year":"2015","unstructured":"DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemp Clin Trials. 2015;45:139\u201345.","journal-title":"Contemp Clin Trials"},{"key":"4382_CR25","doi-asserted-by":"publisher","DOI":"10.1186\/2049-3258-72-39","volume":"72","author":"VN Nyaga","year":"2014","unstructured":"Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health. 2014;72:39.","journal-title":"Arch Public Health"},{"key":"4382_CR26","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1017\/S1138741600005436","volume":"2","author":"F Mar\u00edn-Mart\u00ednez","year":"1999","unstructured":"Mar\u00edn-Mart\u00ednez F, S\u00e1nchez-Meca J. Averaging dependent effect sizes in meta-analysis: a cautionary note about procedures. Span J Psychol. 1999;2:32\u20138.","journal-title":"Span J Psychol"},{"key":"4382_CR27","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","volume":"327","author":"JP Higgins","year":"2003","unstructured":"Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clinical research ed). 2003;327:557\u201360.","journal-title":"BMJ (Clinical research ed)"},{"key":"4382_CR28","doi-asserted-by":"publisher","first-page":"3443","DOI":"10.1002\/sim.2380","volume":"25","author":"RM Harbord","year":"2006","unstructured":"Harbord RM, Egger M, Sterne JA. A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med. 2006;25:3443\u201357.","journal-title":"Stat Med"},{"key":"4382_CR29","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1002\/sim.4780070807","volume":"7","author":"RF Galbraith","year":"1988","unstructured":"Galbraith RF. A note on graphical presentation of estimated odds ratios from several clinical trials. Stat Med. 1988;7:889\u201394.","journal-title":"Stat Med"},{"key":"4382_CR30","first-page":"15","volume":"47","author":"A Tobias","year":"1999","unstructured":"Tobias A. Assessing the influence of a single study in the meta-analysis estimate. Stata Tech Bull. 1999;47:15\u20137.","journal-title":"Stata Tech Bull"},{"key":"4382_CR31","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/S0016-5107(05)01574-9","volume":"62","author":"P Katsinelos","year":"2005","unstructured":"Katsinelos P, Kountouras J, Paroutoglou G, Beltsis A, Mimidis K, Zavos C. Intravenous N-acetylcysteine does not prevent post-ERCP pancreatitis. Gastrointest Endosc. 2005;62:105\u201311.","journal-title":"Gastrointest Endosc"},{"key":"4382_CR32","doi-asserted-by":"publisher","first-page":"300","DOI":"10.12998\/wjcc.v7.i3.300","volume":"7","author":"L Pavel","year":"2019","unstructured":"Pavel L, B\u0103lan GG, Nicorescu A, G\u00eelc\u0103-Blanariu GE, Sfarti C, Chiriac \u0218, et al. Split-dose or hybrid nonsteroidal anti-inflammatory drugs and N-acetylcysteine therapy for prevention of post-retrograde cholangiopancreatography pancreatitis. World J Clin Cases. 2019;7:300\u201310.","journal-title":"World J Clin Cases"},{"key":"4382_CR33","doi-asserted-by":"publisher","first-page":"2968","DOI":"10.3748\/wjg.14.2968","volume":"14","author":"UC Bang","year":"2008","unstructured":"Bang UC, Semb S, Nojgaard C, Bendtsen F. Pharmacological approach to acute pancreatitis. World J Gastroenterol. 2008;14:2968\u201376.","journal-title":"World J Gastroenterol"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-025-04382-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-025-04382-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-025-04382-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T10:51:32Z","timestamp":1762253492000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-025-04382-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,4]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4382"],"URL":"https:\/\/doi.org\/10.1186\/s12876-025-04382-0","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,4]]},"assertion":[{"value":"2 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"783"}}