Peri-Procedural Aggressive Hydration for Post Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis Prophylaxsis: Meta-analysis of Randomized Controlled Trials |
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| Affiliation: | 1. Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA;2. Division of Gastroenterology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA;3. Division of Gastroenterology, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA;4. Division of Gastroenterology, Department of Internal Medicine, Saint Peter''s University Hospital/Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, USA;5. Division of Gastroenterology, Department of Internal Medicine, Mayo Clinic, Florida, USA;1. Division of Gastroenterology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA;2. Saint Peter''s University Hospital/Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, USA;3. Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA;4. Division of Gastroenterology, Mayo Clinic, Jacksonville, FL, USA;1. Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA;2. Division of Gastroenterology, Indiana University Medical Center, Indianapolis, Indiana, USA;3. Division of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina, USA;4. Division of Gastroenterology, University Hospitals Case Medical Center, Cleveland, Ohio, USA;5. Division of Digestive Diseases and Nutrition, University of Kentucky Medical Center, Lexington, Kentucky, USA;6. Division of Gastroenterology and Hepatology, Kantonsspital Graubuenden, Chur, Switzerland;1. Organ Transplantation Center, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People''s Hospital, Chengdu 610072, Sichuan, PR China;2. Department of Health Education, Chengdu Centers for Diseases Control and Prevention, Chengdu 610041, Sichuan, PR China;3. Department of Digestive Surgical Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, PR China;1. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan;2. Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan;3. Department of Gastroenterology, Iwakuni Clinical Center, Iwakuni, Japan;4. Department of Gastroenterology, Mitoyo General Hospital, Kanonji, Japan;5. Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan;6. Department of Gastroenterology, Japanese Red Cross Okayama Hospital, Okayama, Japan;7. Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan;8. Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan;9. Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Japan;10. Department of Internal Medicine, Sumitomo Besshi Hospital, Niihama, Japan;11. Department of Gastroenterology, Onomichi Municipal Hospital, Onomichi, Japan;1. Department of Internal Medicine, Dankook University College of Medicine, Dankook University Hospital, Cheonan, Korea;3. Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea;4. Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea |
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| Abstract: | BackgroundPeriprocedural intravenous hydration is suggested to decrease the risk of post-ERCP pancreatitis (PEP). However, quality of evidence supporting this suggestion remains poor. Here we hypothesized that aggressive hydration(AH) could be an effective preventive measure.MethodsPubmed, EMBASE, CINAHL, Google Scholar, Clinical Trials. gov, Clinical Key, International Standard Randomized Trial Number registry as well as secondary sources were searched through January 2019 to identify randomized controlled studies comparing AH to standard hydration (SH) for prevention of PEP. Pooled odds ratio (OR) and 95% confidence intervals (CIs) were calculated using the random-effects model. RevMan 5.3 was used for analysis.ResultsA total of 9 RCTs, with 2094 patients, were included in the meta-analysis. AH reduced incidence of PEP by 56% compared to SH (OR = 0.44, CI:0.28–0.69; p = 0.0004). The incidence of post-ERCP hyperamylasemia also decreased with AH compared to SH (OR = 0.51; p = 0.001). Length of stay decreased by 1 day with AH (Mean Difference (MD): −0.89 d; p = 0.00002). There was no significant difference in adverse events related to fluid overload between two groups (OR:1.29; p = 0.81) and post-ERCP abdominal pain (OR:0.35; p = 0.17). Numbers of patient to be treated with AH to prevent one episode of PEP was 17. Final results of the meta-analysis were not affected by alternative effect measures or statistical models of heterogeneity.ConclusionAggressive hydration is associated with a significantly lower incidence of PEP and it appears to be an effective and safe strategy for the prevention of Post ERCP pancreatitis. |
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| Keywords: | Prevention Normal saline Ringer's lactate Adverse events Abdominal pain |
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