Short-Term Alterations in Thiol-Disulfide Homeostasis Following ERCP: A Prospective Controlled Study

Endoscopic retrograde cholangiopancreatography (ERCP) is widely used in the management of pancreaticobiliary disorders and may be associated with systemic oxidative stress. Dynamic thiol-disulfide homeostasis, which reflects the balance between reduced and oxidized thiol groups, has emerged as a sensitive indicator of systemic redox status. This study aimed to evaluate alterations in thiol-disulfide homeostasis in patients undergoing ERCP.

In this observational study, patients undergoing ERCP and control subjects were included. Serum native thiol, total thiol, disulfide levels, and thiol-based ratios were measured using an automated spectrophotometric assay. Baseline demographic and laboratory characteristics were compared between groups. Age-adjusted analyses were performed using analysis of covariance (ANCOVA), and longitudinal changes were evaluated using mixed-effects models.

Compared with controls, patients undergoing ERCP demonstrated significantly lower native thiol and total thiol levels together with higher disulfide concentrations and altered thiol-based ratios. Age-adjusted analyses confirmed significant group effects for native thiol, total thiol, disulfide, and native thiol/total thiol ratio. Longitudinal analyses showed partial increases in reduced thiol parameters after ERCP; however, post-procedural values remained lower than those observed in controls at the 24-h time point. These alterations were observed irrespective of post-ERCP pancreatitis or pancreatic enzyme elevations.

Patients undergoing ERCP exhibited significant alterations in thiol-disulfide homeostasis, characterized predominantly by depletion of reduced thiol pools. The observed redox imbalance persisted during the early post-procedural period and appeared to be associated with both underlying pancreaticobiliary disease and procedure-related oxidative stress. Further studies are needed to clarify the clinical significance of these findings.