Aggressive hydration with Lactated Ringer′s solution as the prophylactic intervention for postendoscopic retrograde cholangiopancreatography pancreatitis: A randomized controlled double-blind clinical trial

Abstract

Background:Pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) and may cause significant morbidity and even death. There is no effective prophylactic intervention for patients with average risk yet. This study aims to investigate preventive effect of aggressive hydration for post-ERCP pancreatitis.Materials and Methods:In a double-blind controlled setting, 150 patient were randomly assigned to receive either aggressive hydration with lactated Ringer's solution (3 mL/kg/h during ERCP, followed by a 20 mL/kg bolus and 3 mL/kg/h for 8 h after the procedure, n = 75) or standard amount of hydration (1.5 mL/kg/h during and for 8 h after ERCP, n = 75). Patients were observed for volume overload as well as pancreatic pain and serum levels of amylase at baseline and 2, 8, and 24 h after ERCP. Post-ERCP pancreatitis was defined as hyperamylasemia (level of amylase >300) and pancreatic pain during the 24 h follow-up. Hyperamylasemia and pancreatic pain were the secondary end points.Results:Mean age of the patients was 50.8 ± 13.5 years. Most of the patients were female (66%). Pancreatitis developed in 21 patients, including 22.7% of patients receiving standard hydration and 5.3% patients receiving aggressive hydration (P = 0.002). Hyperamylasemia was detected in 44.0% of patients receiving standard hydration and 22.7% of patients aggressive hydration (P = 0.006). The pancreatic pain was reported by 5.3% of patients receiving aggressive hydration and 37.3% of patients receiving standard hydration (P ≤ 0.005).Conclusion:Aggressive hydration with lactated Ringer's solution may effectively prevent post-ERCP pancreatitis as well as hyperamylasemia and pancreatic pain in patients with average risk.

Fluid type and volume reduce risk of post-ERCP pancreatitis and length of hospital stay in high-risk patients: a secondary analysis of the INDIEH trial

“…Our study further showed that aggressive resuscitation with lactated Ringerʼs (LR) might lead to a lower incidence of PEP in high-risk patients as compared to administration of other fluid types. This has been supported by previous retrospective as well as prospective studies in average and high risk patients 7 8 17 . Mok et el.…”

“…However, this was a pilot study which included only inpatients and was underpowered. Two relatively larger subsequent RCTs showed similar results 8 17 . The previous RCTs administered fluids in patients over 8 hours after ERCP which is a longer PACU recovery period than usual when compared to most centers around the world 7 8 .…”

Effect of Aggressive Fluid Therapy on Outcomes after Endoscopic Retrograde Cholangiopancreatography: A Randomized Controlled Clinical Trial

“…A recent study by Shayegan Nejad and his colleagues is another example in this regard. 22 Their results in terms of the effect of aggressive fluid therapy on the incidence of post-ERCP pancreatitis, hyperamylasemia, and pain are consistent with this study. The advantage of this study over the study by Shayegan Nejad and colleagues is the higher sample size.…”

Comparative effectiveness of aggressive intravenous fluid resuscitation with lactated Ringer’s solution and rectal indomethacin therapy in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: a double blind randomised controlled clinical trial

“…Wu et al showed that IVFR with LRS can reduce the incidence of systemic inflammation in patients with acute pancreatitis in comparison to fluid resuscitation with normal saline [ 9 ]. In a series of average risk patients by Shaygan-nejad et al , the rates of post-ERCP with aggressive and standard IVFR were 5.3% and 22.7%, respectively ( p = 0.002) [ 10 ].…”