NSAIDs are not enough – a double blinded randomized controlled trial on the impact of intensive hydration for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Issue 7 (8th April 2022)

• Record Type: Journal Article
• Authors: Boal Carvalho, Pedro; Magalhães, Joana; Dias de Castro, Francisca; Cúrdia Gonçalves, Tiago; Monteiro, Sara; Xavier, Sofia; Rosa, Bruno; Cotter, José
• Is Part Of: European journal of gastroenterology & hepatology. Volume 34:Issue 7(2022)
• Page Start: 751
• Page End: 756
• Publication Date: 2022-04-08
• Subjects: ERCP -- pancreatitis -- NSAIDs -- Ringer's lactate -- amylase -- lipase; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000002380
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Background: Pancreatitis is the most common complication following endoscopic retrograde cholangiopancreatography (ERCP). In patients receiving NSAID prophylaxis, we aimed to assess whether periprocedural intensive hydration (IH) resulted in a lower incidence of PEP when compared to standard hydration (SH). Material and Methods: Prospective, single-center, double-blinded randomized controlled trial, with inclusion of consecutive patients submitted to inaugural ERCP between January 2015 and December 2018. Patients were randomized on admission, in a 1:1 ratio, to either SH–Ringer's Lactate (RL) at a rate of 1.5 mL/kg/h during and for 8 h following the procedure, or IH–RL at a rate of 3 mL/kg/h during and for 8 h following the procedure, with an additional bolus of 20 mL/kg at the end of the procedure. PEP incidence and severity were assessed according to the Atlanta Guidelines. Results: A total of 155 patients were randomized (83 to IH, 72 to SH). PEP was observed in 8, 4% ( n = 13) of the patients, and was significantly less frequent in IH patients when compared to SH (3, 6% vs 13, 9%, P = 0, 021; relative risk 0.233 [95% IC, 0.061–0.881]); five patients in the SH group developed moderate to severe PEP, in contrast to 0 patients in the IH group (6.9% vs 0.0%, P = 0, 020). Conclusions: Intensive hydration significantly decreased the risk of post-ERCP pancreatitis by four-fold. Moreover, no cases of moderate or severe pancreatitis were observed in patients submitted to this intervention. Associated with nonsteroidal anti-inflammatory drugs, intensive hydration could constitute a new standard of care for patients undergoing ERCP.