Antioxidant drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis: What does evidence suggest?

Table 2 Definition and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis

Ref.	Definition of post-ERCP pancreatitis	Severity of post-ERCP pancreatitis
Wollschläger et al[34], 1999	Abdominal pain attributed to pancreatitis, in association with a serum lipase or amylase level ≥ 2 times the upper limit of normal	NA
Budzyńska et al[35], 2001	Abdominal pain attributed to pancreatitis, together with a need for an unplanned hospitalization or an extension of a planned hospitalization by at least 2 d, and a serum amylase level ≥ 3 times the upper limit of normal at 24 h after ERCP	Mild: symptoms lasting up to 3 d and pancreas normal on the CT scan. Moderate: requiring specific therapeutic measures for 4-10 d, Balthazar’s grade B/C on CT. Severe: local or systemic complications for more than 10 d, Balthazar’s grade D/F on CT, or death
Lavy et al[36], 2004	Abdominal pain attributed to pancreatitis, in association with an amylase level ≥ 3 times the upper limit of normal	Mild: requiring 2-3 d of hospitalization. Moderate: requiring 4-10 d of hospitalization. Severe: requiring 10 d of hospitalization or requiring surgical intervention or leading to death
Katsinelos et al[37], 2005	Abdominal pain attributed to pancreatitis, together with a need for an unplanned hospitalization or an extension of a planned hospitalization by at least 2 d, and a serum amylase level ≥ 3 times the upper limit of normal at 24 h after ERCP	Mild: symptoms persisting for 3 d and a normal appearance of the pancreas by US and/or CT. Moderate: requirement for specific therapeutic measures for 4-10 d (Balthazar’s grade B/C on CT). Severe: local or systemic complications for more than 10 d after ERCP (Balthazar’s grade D/F) or death
Katsinelos et al[38], 2005	Abdominal pain attributed to pancreatitis, together with a need for an unplanned hospitalization or an extension of a planned hospitalization by at least 2 d, and a serum amylase level ≥ 3 times above the upper limit of normal at 24 h after ERCP	Mild: symptoms persisting for 3 d and a normal appearance of the pancreas by US and/or CT. Moderate: requirement for specific therapeutic measures for 4-10 d (Balthazar’s grade B/C on CT). Severe: local or systemic complications for more than 10 d after ERCP (Balthazar’s grade D/F) or death
Mosler et al[39], 2005	New-onset or increased abdominal pain lasting for more than 24 h, causing the unplanned admission of an outpatient for more than one night or prolonging a planned admission of an inpatient, and associated with a serum amylase level ≥ 3 times the normal level, at approximately 18 h (the next morning) after ERCP	Mild: hospitalization lasting 2-3 d. Moderate: hospitalization lasting 4-10 d. Severe: hospitalization prolonged for more than 10 d or any of the following: hemorrhagic pancreatitis, pancreatic necrosis, pancreatic pseudocyst, or the need for percutaneous drainage or surgery
Milewski et al[40], 2006	Clinical features consistent with acute pancreatitis beginning after ERCP and lasting for at least 24 h, associated with a serum amylase level > 5 times the normal level	NA
Kapetanos et al[41], 2007	Abdominal pain attributed to pancreatitis, together with a need for an unplanned hospitalization or an extension of a planned hospitalization by at least 2 d, and a serum amylase level ≥ 3 times the upper limit of normal at 24 h after ERCP	Mild: clinical pancreatitis and serum amylase at least three times higher than normal at more than 24 h after ERCP, requiring admission or prolongation of planned admission for 2-3 d. Moderate: required hospitalization for 4-10 d. Severe: required hospitalization for more than 10 d, an intervention (percutaneous drainage or surgery), or diagnosis of a pseudocyst
Romagnuolo et al[42], 2008	Abdominal pain attributed to pancreatitis requiring medical attention, in association with a serum lipase or amylase level > 2 times the upper limit of normal	NA
Martinez-Torres et al[43], 2009	Serum amylase level above 600 IU/L or ≥ 3 times the normal value, and sharp pain irradiating to the back and nausea or vomiting	Mild: two or fewer signs from Ranson’s criteria. Moderate: three to six signs. Severe: more than six signs. The criteria were as follows. At admission: age, > 55 yr; WBC count, > 16000/mL; serum glucose level, > 11.1 mmol/L; SLDH/ALT, > 350 IU/L; AST level, > 250 IU/L. During initial 48 h: hematocrits, decrease of more than 0.10; BUN level, increase of more than 5 mg/dL; calcium, < 2 mmol/L; PaO2, < 60 mmHg; base deficit, > 4 mmol/L; fluid sequestration, > 6 L
Abbasinazari et al[44], 2011	NA	Mild: amylase concentration at least three times the upper limit of normal at more than 24 h after ERCP, requiring admission for 2-3 d. Moderate: admission for 4-10 d. Severe: admission for more than 10 d
Alavi Nejad et al[45], 2013	Serum amylase level > 275 U/mL or serum lipase level > 1000 U/mL with the presence of abdominal pain	The severity of pancreatitis based on the number of hospitalized days following ERCP. Mild: < 4 d. Moderate: 4-10 d. Severe: > 10 d

CT: Computed tomography; US: Ultrasound; ERCP: Endoscopic retrograde cholangiopancreatography; NA: Not available; AST: Aspartate aminotransferase; BUN: Blood urea nitrogen; SLDH/ALT: Serum lactate dehydrogenate to alanine aminotransferase ratio; WBC: White blood cell.