Aggressive intravenous hydration with lactated Ringer's solution for prevention of post-ERCP pancreatitis: a prospective randomized multicenter clinical trial
- Authors
- Park, Chang-Hwan; Paik, Woo Hyun; Park, Eun Taek; Shim, Chan Sup; Lee, Tae Yoon; Kang, Changdon; Noh, Myung Hwan; Yi, Sun Youn; Lee, Jong Kyun; Hyun, Jong Jin; Lee, Jun Kyu
- Issue Date
- 4월-2018
- Publisher
- GEORG THIEME VERLAG KG
- Citation
- ENDOSCOPY, v.50, no.4, pp.378 - 385
- Indexed
- SCIE
SCOPUS
- Journal Title
- ENDOSCOPY
- Volume
- 50
- Number
- 4
- Start Page
- 378
- End Page
- 385
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/76186
- DOI
- 10.1055/s-0043-122386
- ISSN
- 0013-726X
- 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.
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