Aggressive intravenous hydration with lactated Ringer's solution for prevention of post-ERCP pancreatitis: A prospective randomized multicenter clinical trial

Chang Hwan Park, Woo Hyun Paik, Eun Taek Park, Chan Sup Shim, Tae Yoon Lee, Changdon Kang, Myung Hwan Noh, Sun Youn Yi, Jong Kyun Lee, Jong Jin Hyun, Jun Kyu Lee

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background and study aims: The present study aimed to determine the type of intravenous hydration that is best suited to reducing the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Patients and methods :In a prospective randomized multicenter trial, average-to-high risk patients who underwent first-time ERCP were randomly assigned to three groups (1:1:1) who received: aggressive intravenous hydration (3 mL/kg/h during ERCP, a 20-mL/kg bolus and 3 mL/kg/h for 8 hours after ERCP) with either lactated Ringer's solution (LRS) or normal saline solution (NSS), or standard intravenous hydration with LRS (1.5 mL/kg/h during and for 8 hours after ERCP). The primary end point was post-ERCP pancreatitis (PEP). Results :395 patients were enrolled, and 385 completed the protocols. The three groups showed no significant differences in demographic characteristics. There was a significant difference in the intention-to-treat (ITT) PEP rate between the aggressive LRS group (3.0 %, 95 % confidence interval [CI] 0.1 % - 5.9 %; 4 /132), the aggressive NSS group (6.7 %, 95 %CI 2.5 % - 10.9 %; 9 /134) and the standard LRS group (11.6 %, 95 %CI 6.1 % - 17.2 %; 15 /129; P = 0.03). In the two-group comparisons, the ITT PEP rate was significantly lower for the aggressive LRS group than for the standard LRS group (relative risk [RR] 0.26, 95 %CI 0.08 - 0.76; P = 0.008). There was no significant difference in the ITT PEP rate between the aggressive NSS group and the standard LRS group (RR 0.57, 95 %CI 0.26 - 1.27; P = 0.17). Conclusion :Aggressive hydration with LRS is the best approach to intravenous hydration for the prevention of PEP in average-to-high risk patients.

Original languageEnglish
Pages (from-to)378-385
Number of pages8
JournalEndoscopy
Volume50
Issue number4
DOIs
Publication statusPublished - 2018 Apr 1

ASJC Scopus subject areas

  • Gastroenterology

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