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Aggressive hydration with lactated Ringer's solution reduces pancreatitis after endoscopic retrograde cholangiopancreatography.
Clin Gastroenterol Hepatol 2014; 12(2):303-7.e1CG

Abstract

BACKGROUND & AIMS

Pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP). We performed a pilot study to determine whether aggressive periprocedural hydration with lactated Ringer's solution reduces the incidence of pancreatitis after ERCP.

METHODS

Patients who underwent first-time ERCP were randomly assigned to groups (2:1) that received aggressive hydration with lactated Ringer's solution (3 mL/kg/h during the procedure, a 20-mL/kg bolus after the procedure, and 3 mL/kg/h for 8 hours after the procedure, n = 39) or standard hydration with the same solution (1.5 mL/kg/h during and for 8 hours after procedure, n = 23). Serum levels of amylase, visual analogue pain scores (scale of 0-10), and volume overload were assessed at baseline and 2, 8, and 24 hours after ERCP. The primary end point, post-ERCP pancreatitis, was defined as hyperamylasemia (level of amylase >3 times the upper limit of normal) and increased epigastric pain (≥3 points on visual analogue scale) persisting for ≥24 hours after the procedure. Secondary end points included hyperamylasemia, increased pain, and volume overload.

RESULTS

None of the patients who received aggressive hydration developed post-ERCP pancreatitis, compared with 17% of patients who received standard hydration (P = .016). Hyperamylasemia developed in 23% of patients who received aggressive hydration vs 39% of those who received standard hydration (P = .116, nonsignificant); increased epigastric pain developed in 8% of patients who received aggressive hydration vs 22% of those who received standard hydration (P = .146, nonsignificant). No patients had evidence of volume overload.

CONCLUSIONS

On the basis of a pilot study, aggressive intravenous hydration with lactated Ringer's solution appears to reduce the development of post-ERCP pancreatitis and is not associated with volume overload. ClinicalTrials.gov, Number: NCT 01758549.

Authors+Show Affiliations

Division of Gastroenterology, University of Southern California, Los Angeles, California.Division of Gastroenterology, University of Southern California, Los Angeles, California.Division of Gastroenterology, University of Southern California, Los Angeles, California.Division of Gastroenterology, University of Southern California, Los Angeles, California.Division of Gastroenterology, University of Southern California, Los Angeles, California.Yale University School of Medicine, New Haven, Connecticut and VA Connecticut Healthcare System, West Haven, Connecticut. Electronic address: loren.laine@yale.edu.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

23920031

Citation

Buxbaum, James, et al. "Aggressive Hydration With Lactated Ringer's Solution Reduces Pancreatitis After Endoscopic Retrograde Cholangiopancreatography." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 12, no. 2, 2014, pp. 303-7.e1.
Buxbaum J, Yan A, Yeh K, et al. Aggressive hydration with lactated Ringer's solution reduces pancreatitis after endoscopic retrograde cholangiopancreatography. Clin Gastroenterol Hepatol. 2014;12(2):303-7.e1.
Buxbaum, J., Yan, A., Yeh, K., Lane, C., Nguyen, N., & Laine, L. (2014). Aggressive hydration with lactated Ringer's solution reduces pancreatitis after endoscopic retrograde cholangiopancreatography. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 12(2), pp. 303-7.e1. doi:10.1016/j.cgh.2013.07.026.
Buxbaum J, et al. Aggressive Hydration With Lactated Ringer's Solution Reduces Pancreatitis After Endoscopic Retrograde Cholangiopancreatography. Clin Gastroenterol Hepatol. 2014;12(2):303-7.e1. PubMed PMID: 23920031.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aggressive hydration with lactated Ringer's solution reduces pancreatitis after endoscopic retrograde cholangiopancreatography. AU - Buxbaum,James, AU - Yan,Arthur, AU - Yeh,Kelvin, AU - Lane,Christianne, AU - Nguyen,Nancy, AU - Laine,Loren, Y1 - 2013/08/03/ PY - 2013/07/10/received PY - 2013/07/10/accepted PY - 2013/8/8/entrez PY - 2013/8/8/pubmed PY - 2014/8/12/medline KW - CI KW - Clinical Trial KW - ERCP KW - Endoscopic Retrograde Cholangiopancreatography KW - Inflammation KW - Outcome KW - Pancreas KW - confidence interval KW - endoscopic retrograde cholangiopancreatography SP - 303 EP - 7.e1 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 12 IS - 2 N2 - BACKGROUND & AIMS: Pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP). We performed a pilot study to determine whether aggressive periprocedural hydration with lactated Ringer's solution reduces the incidence of pancreatitis after ERCP. METHODS: Patients who underwent first-time ERCP were randomly assigned to groups (2:1) that received aggressive hydration with lactated Ringer's solution (3 mL/kg/h during the procedure, a 20-mL/kg bolus after the procedure, and 3 mL/kg/h for 8 hours after the procedure, n = 39) or standard hydration with the same solution (1.5 mL/kg/h during and for 8 hours after procedure, n = 23). Serum levels of amylase, visual analogue pain scores (scale of 0-10), and volume overload were assessed at baseline and 2, 8, and 24 hours after ERCP. The primary end point, post-ERCP pancreatitis, was defined as hyperamylasemia (level of amylase >3 times the upper limit of normal) and increased epigastric pain (≥3 points on visual analogue scale) persisting for ≥24 hours after the procedure. Secondary end points included hyperamylasemia, increased pain, and volume overload. RESULTS: None of the patients who received aggressive hydration developed post-ERCP pancreatitis, compared with 17% of patients who received standard hydration (P = .016). Hyperamylasemia developed in 23% of patients who received aggressive hydration vs 39% of those who received standard hydration (P = .116, nonsignificant); increased epigastric pain developed in 8% of patients who received aggressive hydration vs 22% of those who received standard hydration (P = .146, nonsignificant). No patients had evidence of volume overload. CONCLUSIONS: On the basis of a pilot study, aggressive intravenous hydration with lactated Ringer's solution appears to reduce the development of post-ERCP pancreatitis and is not associated with volume overload. ClinicalTrials.gov, Number: NCT 01758549. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/23920031/Aggressive_hydration_with_lactated_Ringer's_solution_reduces_pancreatitis_after_endoscopic_retrograde_cholangiopancreatography_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(13)01090-2 DB - PRIME DP - Unbound Medicine ER -