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Aggressive Hydration With Lactated Ringer Solution in Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: A Meta-analysis of Randomized Controlled Trials.
J Clin Gastroenterol 2017; 51(3):e17-e26JC

Abstract

BACKGROUND

Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The results of previous studies evaluating aggressive hydration with lactated Ringer solution for reducing the incidence of post-ERCP pancreatitis (PEP) are inconsistent.

AIM

We performed a meta-analysis to determine whether aggressive hydration with lactated Ringer solution reduced PEP.

METHODS

Randomized controlled trials (RCTs) comparing aggressive hydration with standard hydration with the same lactated Ringer solution for prophylaxis of PEP were searched in PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases. ClinicalTrial.gov and International Standard Randomised Controlled Trial Number registry were also searched for unpublished studies. A meta-analysis was conducted in accordance with the Cochrane Handbook for Systemic Reviews of Intervention.

RESULTS

A total of 7 RCTs with 1047 participants were included into this meta-analysis. Meta-analysis showed that aggressive hydration reduced the incidence of PEP as compared with standard hydration [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.30-0.72; P=0.0006]. Aggressive hydration also reduced the incidence of post-ERCP hyperamylasemia as compared with standard hydration (OR, 0.38; 95% CI, 0.25-0.59; P<0.00001). No difference of adverse effects was found between aggressive hydration and standard hydration (OR, 0.48; 95% CI, 0.15-1.57; P=0.23). Sensitivity analyses showed that neither alternative effect measures nor statistical models regarding heterogeneity affected the conclusions of this meta-analysis. Sensitivity analyses also showed that omitting 1 study from analysis did not change the conclusion of this meta-analysis.

CONCLUSIONS

On the basis of this meta-analysis of RCTs, aggressive hydration with lactated Ringer solution is an effective and safe therapy for prophylaxis of PEP.

Authors+Show Affiliations

*Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China †Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong Province.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

28178088

Citation

Zhang, Zhi-Feng, et al. "Aggressive Hydration With Lactated Ringer Solution in Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: a Meta-analysis of Randomized Controlled Trials." Journal of Clinical Gastroenterology, vol. 51, no. 3, 2017, pp. e17-e26.
Zhang ZF, Duan ZJ, Wang LX, et al. Aggressive Hydration With Lactated Ringer Solution in Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: A Meta-analysis of Randomized Controlled Trials. J Clin Gastroenterol. 2017;51(3):e17-e26.
Zhang, Z. F., Duan, Z. J., Wang, L. X., Zhao, G., & Deng, W. G. (2017). Aggressive Hydration With Lactated Ringer Solution in Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: A Meta-analysis of Randomized Controlled Trials. Journal of Clinical Gastroenterology, 51(3), pp. e17-e26. doi:10.1097/MCG.0000000000000781.
Zhang ZF, et al. Aggressive Hydration With Lactated Ringer Solution in Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: a Meta-analysis of Randomized Controlled Trials. J Clin Gastroenterol. 2017;51(3):e17-e26. PubMed PMID: 28178088.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aggressive Hydration With Lactated Ringer Solution in Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: A Meta-analysis of Randomized Controlled Trials. AU - Zhang,Zhi-Feng, AU - Duan,Zhi-Jun, AU - Wang,Li-Xia, AU - Zhao,Gang, AU - Deng,Wu-Guo, PY - 2017/2/9/entrez PY - 2017/2/9/pubmed PY - 2017/12/14/medline SP - e17 EP - e26 JF - Journal of clinical gastroenterology JO - J. Clin. Gastroenterol. VL - 51 IS - 3 N2 - BACKGROUND: Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The results of previous studies evaluating aggressive hydration with lactated Ringer solution for reducing the incidence of post-ERCP pancreatitis (PEP) are inconsistent. AIM: We performed a meta-analysis to determine whether aggressive hydration with lactated Ringer solution reduced PEP. METHODS: Randomized controlled trials (RCTs) comparing aggressive hydration with standard hydration with the same lactated Ringer solution for prophylaxis of PEP were searched in PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases. ClinicalTrial.gov and International Standard Randomised Controlled Trial Number registry were also searched for unpublished studies. A meta-analysis was conducted in accordance with the Cochrane Handbook for Systemic Reviews of Intervention. RESULTS: A total of 7 RCTs with 1047 participants were included into this meta-analysis. Meta-analysis showed that aggressive hydration reduced the incidence of PEP as compared with standard hydration [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.30-0.72; P=0.0006]. Aggressive hydration also reduced the incidence of post-ERCP hyperamylasemia as compared with standard hydration (OR, 0.38; 95% CI, 0.25-0.59; P<0.00001). No difference of adverse effects was found between aggressive hydration and standard hydration (OR, 0.48; 95% CI, 0.15-1.57; P=0.23). Sensitivity analyses showed that neither alternative effect measures nor statistical models regarding heterogeneity affected the conclusions of this meta-analysis. Sensitivity analyses also showed that omitting 1 study from analysis did not change the conclusion of this meta-analysis. CONCLUSIONS: On the basis of this meta-analysis of RCTs, aggressive hydration with lactated Ringer solution is an effective and safe therapy for prophylaxis of PEP. SN - 1539-2031 UR - https://www.unboundmedicine.com/medline/citation/28178088/Aggressive_Hydration_With_Lactated_Ringer_Solution_in_Prevention_of_Postendoscopic_Retrograde_Cholangiopancreatography_Pancreatitis:_A_Meta_analysis_of_Randomized_Controlled_Trials_ L2 - http://Insights.ovid.com/pubmed?pmid=28178088 DB - PRIME DP - Unbound Medicine ER -