The Efficiency of Aggressive Hydration With Lactated Ringer Solution for the Prevention of Post-ERCP Pancreatitis

Wu, Dangyan; Wan, Jianhua; Xia, Liang; Chen, Jie; Zhu, Yin; Lü, Nonghua

doi:10.1097/mcg.0000000000000856

Cited by 51 publications

(41 citation statements)

References 20 publications

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“…ERCP advanced endoscopy meetings, such as the one held in Portugal in 2016, could be the perfect occasion to discuss this and other topics, as most Portuguese endoscopists performing ERCP would be present. Furthermore, other ERCP research projects could be fostered, ranging from insights into other practice dimensions, such as the use of intensive hydration in the periprocedural period with intravenous lactated Ringer solution to validation studies [35]. …”

Section: Discussionmentioning

confidence: 99%

ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

Lopes

Canena

2018

GE Port J Gastroenterol

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Background/Aims: Recently the European Society of Gastrointestinal Endoscopy delivered guidelines on the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and on the papillary cannulation and sphincterotomy techniques at endoscopic retrograde cholangiopancreatography (ERCP). There are no data concerning current practices in Portugal. The aim of this study was to capture practice patterns of Portuguese pancreaticobiliary endoscopists with special interest in the prevention of PEP and cannulation techniques. Methods: A written survey was distributed to all pancreaticobiliary endoscopists attending the first Portuguese meeting dedicated to ERCP in November 2016. The main outcome measures were: technique used for standard biliary cannulation, use of nonsteroidal anti-inflammatory drugs (NSAIDs) in PEP, attempting prophylactic pancreatic stenting after using pancreatic guidewire (PGW)-assisted biliary cannulation in patients where biliary cannulation was difficult, and use of precut as the first rescue technique when biliary cannulation was difficult. Results: Completed surveys were collected from 28 of the 32 pancreatobiliary endoscopists attending the meeting (answer rate 87.5%). Biliary cannulation was performed using a guidewire access technique by the majority (77%), usually with a sphincterotome. When cannulation was unsuccessful, precut was the first choice for 70%. NSAIDs were administered routinely for PEP by only 54%; PGW-assisted biliary cannulation was the first choice after failed standard cannulation for a minority of them, and only 27% reported to routinely attempt insertion of a pancreatic stent. High-volume endoscopists (> 150/year) tended to use NSAIDs and to insert a stent in PGW-assisted cannulation less often than low-volume-endoscopists (50 vs. 83.3%, p < 0.01, and 40 vs. 100%, p < 0.01, respectively). Precut was started without prior formal training by more than half of the endoscopists. Conclusions: There is a pronounced discrepancy between evidence-based guidelines and current clinical practice. This discrepancy is more pronounced in PEP prophylaxis, especially among high-volume endoscopists. Some advanced techniques in ERCP are initiated unsupervised, without any previous formal training. Key Message: There is a significant gap between guidelines and routine clinical practice.

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Section: Discussionmentioning

confidence: 99%

ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

Lopes

Canena

2018

GE Port J Gastroenterol

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“…Mok et al also evaluated the additive effect of aggressive hydration with LRS and indomethacin in an RCT study of 192 patients with high‐risk of PEP and reported that the combination to reduce PEP incidence significantly . Another meta‐analysis including 722 patients from 3 RCTs concluded that aggressive hydration with LRS could significantly reduce the incidence of PEP . The optimal timing and safety of aggressive hydration with LRS needs to be evaluated in larger studies for conclusive results, especially in Chinese populations.…”

Section: Medical Prevention Of Post‐ercp Complicationsmentioning

confidence: 99%

“…However, the patients in both studies underwent diagnostic ERCP without using only guidewire, and the intubation time was long. Further, the definition of PEP in these studies were not standardized …”

Section: Medical Prevention Of Post‐ercp Complicationsmentioning

confidence: 99%

Chinese expert consensus on perioperative medications for endoscopic retrograde cholangiopancreatography (ERCP)

Bai

Wang

et al. 2019

J of Digest Diseases

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“…In 2014, two hypothesis-generating retrospective studies reported that greater peri-procedural intravenous fluid volume was an independent protective factor against moderate to severe PEP 94 and was associated with shorter hospital LOS 95 . Very recent meta-analyses and RCTs support using LR prior to ERCP to prevent PEP 96– 99 and to reduce moderate to severe PEP 96, 97 . Interestingly, a recent RCT shows that the combination of rectal indomethacin and LR compared with combination placebo and normal saline reduced the risk of PEP in high-risk patients 100 .…”

Section: Recent Advances In Early Treatment Of Acute Pancreatitismentioning

confidence: 99%

Recent advances in understanding and managing acute pancreatitis

Mandalia¹,

Wamsteker²,

DiMagno³

2018

F1000Res

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This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

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The Efficiency of Aggressive Hydration With Lactated Ringer Solution for the Prevention of Post-ERCP Pancreatitis

Abstract: Aggressive hydration with lactated Ringer solution can reduce the overall incidence of PEP, moderate to severe pancreatitis and hyperamylasemia, shorten the length of hospitalization and reduce pain.

Cited by 51 publications

References 20 publications

ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

Chinese expert consensus on perioperative medications for endoscopic retrograde cholangiopancreatography (ERCP)

Recent advances in understanding and managing acute pancreatitis

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