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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(07): E933-E939
DOI: 10.1055/a-1834-6568
Original article

Efficacy of aggressive hydration with normal saline versus lactated Ringer’s solution for the prevention of post-ERCP pancreatitis in high-risk patients: a randomized controlled trial

Rupal Patel
1   University of South Florida College of Medicine, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Tampa, Florida, United States
,
Carlos Bertran-Rodriguez
2   University of South Florida College of Medicine, Department of Internal Medicine, Tampa, Florida, United States
,
Ambuj Kumar
3   University of South Florida College of Medicine, Office of Research, Department of Internal Medicine, Tampa, Florida, United States
,
Patrick Brady
1   University of South Florida College of Medicine, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Tampa, Florida, United States
,
Rene Gomez-Esquivel
1   University of South Florida College of Medicine, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Tampa, Florida, United States
,
Kinesh Changela
1   University of South Florida College of Medicine, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Tampa, Florida, United States
,
Negar Niknam
1   University of South Florida College of Medicine, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Tampa, Florida, United States
,
Pushpak Taunk
1   University of South Florida College of Medicine, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Tampa, Florida, United States
› Author AffiliationsTRIAL REGISTRATION: Randomized blinded controlled trial at http://www.clinicaltrials.gov/
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Abstract

Background and study aims Post-ERCP pancreatitis (PEP) is a common adverse event in high-risk patients. Current intervention known to reduce the incidence and severity of PEP include pancreatic duct stent placement, nonsteroidal anti-inflammatory drugs per rectum, and intravenous (IV) fluids. We compared aggressive normal saline (NS) vs aggressive lactated Ringer’s (LR) infusion for the prevention of PEP in high-risk patients undergoing ERCP.

Patients and methods Patients were randomized to receive either an aggressive infusion of NS or LR. The infusion was started at a rate of 3 mL/kg/hr and continued throughout the ERCP procedure. A 20 mL/kg bolus was given at the end of the procedure, then continued at a rate of 3 mL/kg/hr.

Results A total of 136 patients were included in our analysis. The incidence of PEP was 4 % (3/72 patients) in the LR group versus 11 % (7/64 patients) in the NS group resulting in a relative risk (RR) of 0.38 (95 % confidence interval [CI] 0.10 to 1.42; P = 0.19). The relative risk reduction (RRR) was 0.62 (95 % CI –0.41 to 0.90) along with an absolute risk reduction (ARR) of 0.07 (95 % CI –0.025 to 0.17) and an number needed to treat of 15 (95 % CI –41 to 6).

Conclusions To our knowledge, this is the first study comparing aggressive IV NS to aggressive IV LR in high-risk patients. The incidence of PEP was lower in the group receiving an aggressive LR infusion (4 %) compared to NS infusion (11 %). However, the difference was not statistically significant likely due to poor accrual thereby impacting the power of the study.



Publication History

Received: 15 July 2021

Accepted after revision: 25 April 2022

Accepted Manuscript online:
25 April 2022

Article published online:
15 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2022; 54(08): 835-835
DOI: 10.1055/a-1803-0512

 

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