Intrabiliary Acetylcysteine Infusion for Biliary Obstruction in a Case of Chronic Pancreatitis with Pancreatic Head IPMN

Abstract

Successful biliary drainage in case of intraductal papillary mucinous neoplasm (IPMN) with thick mucus by ERCP and internal drainage alone is usually inadequate. The mucolytic properties of acetylcysteine can offer a therapeutic benefit in this setting. We report a 50-year-old man with chronic pancreatitis and IPMN who had recurrent episodes of biliary obstruction due to mucous occlusion, despite multiple stent exchanges. A nasobiliary catheter was placed and infusion of acetylcysteine was performed which resulted in significant improvement of jaundice. He later underwent surgery after nutritional rehabilitation. This case report highlights the role of intrabiliary acetylcysteine infusions for mucous occlusions in IPMN.

Keywords

acetylcysteine - cholangitis - IPMN - chronic pancreatitis

Publikationsverlauf

Artikel online veröffentlicht:
03. Juli 2020

• References

• 1 Tanaka M, Fernández-del Castillo C, Adsay V. et al. International Association of Pancreatology. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12 (03) 183-197
• 2 Demedts M, Behr J, Buhl R. et al. High-dose acetylcysteine in idiopathic pul- monarybrosis. N Engl J Med 2005; 353: 2229-2242
• 3 Sadowska AM. N-acetylcysteine mucolysis in the management of chronic obstructive pulmonary disease. Ther Adv Respir Dis 2012; 6 (03) 127-135
• 4 Hu LH, Liu MH, Liao Z. et al. Continuous infusion of N-acetylcysteine by nasobiliary for advanced intraductal papillary mucinous neoplasm of bile ducts (with video). Am J Gastroenterol 2012; 107 (12) 1929-1930