Background & Aims
Pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP). We performed a pilot study to determine whether aggressive peri-procedural hydration with lactated Ringer’s solution reduces the incidence of pancreatitis following ERCP.
Methods
Patients who underwent first-time ERCP were randomly assigned to groups (2:1) that received aggressive hydration with lactated Ringer’s solution (3 cc/kg/hr during the procedure, a 20 cc/kg bolus after the procedure, and 3cc/kg/hr for 8 hours following the procedure, n=39) or standard hydration with the same solution (1.5 cc/kg/hr during and for 8 hrs after procedure, n=23). Serum levels of amylase, visual analog pain scores (scale of 0–10), and volume overload were assessed at baseline and 2, 8, and 24 hrs after ERCP. The primary endpoint, post-ERCP pancreatitis was defined as hyperamylasemia (level of amylase > 3 times the upper limit of normal) and increased epigastric pain (≥3 points on visual analog scale) persisting for ≥24 hrs after the procedure. Secondary endpoints included hyper-amylasemia, increased pain, and volume overload.
Results
None of the patients who received aggressive hydration developed post-ERCP pancreatitis, compared with 17% of patients who received standard hydration (P=.016).
Hyperamylasemia developed in 23% of patients who received aggressive hydration vs 39% of those who received standard hydration (P=.116, non-significant); increased epigastric pain developed in 8% of patients who received aggressive hydration vs 22% of those who received standard hydration (P=.146, non-significant). No patients had evidence of volume overload.
Conclusions
Based on a pilot study, aggressive intravenous hydration with lactated Ringer’s solution appears to reduce the development of post-ERCP pancreatitis and is not associated with volume overload. ClinicalTrials.gov number, NCT 01758549
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