Tags

Type your tag names separated by a space and hit enter

Aggressive intravenous hydration with lactated Ringer's solution for prevention of post-ERCP pancreatitis: a prospective randomized multicenter clinical trial.
Endoscopy 2018; 50(4):378-385E

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.

Authors+Show Affiliations

Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea.Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.Department of Internal Medicine, Gospel Hospital, University of Kosin College of Medicine, Busan, South Korea.Digestive Disease Center, Konkuk University School of Medicine, Seoul, South Korea.Digestive Disease Center, Konkuk University School of Medicine, Seoul, South Korea.Department of Internal Medicine, School of Medicine, Kangwon National University, Kangwon, South Korea.Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea.Department of Internal Medicine, School of Medicine, Ewha Woman's University, Seoul, South Korea.Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.Department of Medicine, Korea University Ansan Hospital, Seoul, South Korea.Dongguk University Ilsan Hospital, Goyang, South Korea.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

29237204

Citation

Park, Chang-Hwan, et al. "Aggressive Intravenous Hydration With Lactated Ringer's Solution for Prevention of post-ERCP Pancreatitis: a Prospective Randomized Multicenter Clinical Trial." Endoscopy, vol. 50, no. 4, 2018, pp. 378-385.
Park CH, Paik WH, Park ET, et al. Aggressive intravenous hydration with lactated Ringer's solution for prevention of post-ERCP pancreatitis: a prospective randomized multicenter clinical trial. Endoscopy. 2018;50(4):378-385.
Park, C. H., Paik, W. H., Park, E. T., Shim, C. S., Lee, T. Y., Kang, C., ... Lee, J. K. (2018). Aggressive intravenous hydration with lactated Ringer's solution for prevention of post-ERCP pancreatitis: a prospective randomized multicenter clinical trial. Endoscopy, 50(4), pp. 378-385. doi:10.1055/s-0043-122386.
Park CH, et al. Aggressive Intravenous Hydration With Lactated Ringer's Solution for Prevention of post-ERCP Pancreatitis: a Prospective Randomized Multicenter Clinical Trial. Endoscopy. 2018;50(4):378-385. PubMed PMID: 29237204.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aggressive intravenous hydration with lactated Ringer's solution for prevention of post-ERCP pancreatitis: a prospective randomized multicenter clinical trial. AU - Park,Chang-Hwan, AU - Paik,Woo Hyun, AU - Park,Eun Taek, AU - Shim,Chan Sup, AU - Lee,Tae Yoon, AU - Kang,Changdon, AU - Noh,Myung Hwan, AU - Yi,Sun Youn, AU - Lee,Jong Kyun, AU - Hyun,Jong Jin, AU - Lee,Jun Kyu, Y1 - 2017/12/13/ PY - 2017/12/14/pubmed PY - 2019/3/15/medline PY - 2017/12/14/entrez SP - 378 EP - 385 JF - Endoscopy JO - Endoscopy VL - 50 IS - 4 N2 - : 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. SN - 1438-8812 UR - https://www.unboundmedicine.com/medline/citation/29237204/Aggressive_intravenous_hydration_with_lactated_Ringer's_solution_for_prevention_of_post_ERCP_pancreatitis:_a_prospective_randomized_multicenter_clinical_trial_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0043-122386 DB - PRIME DP - Unbound Medicine ER -