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Comparative effectiveness of aggressive intravenous fluid resuscitation with lactated Ringer's solution and rectal indomethacin therapy in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: a double blind randomised controlled clinical trial.
Prz Gastroenterol 2017; 12(4):271-276PG

Abstract

Introduction

There is growing evidence indicating the aggressive intravenous fluid resuscitation (IVFR) can decrease the rate of pancreatitis; however, to the best of our knowledge it has not been well studied in a post-endoscopic retrograde cholangiopancreatography (post-ERCP) setting.

Aim

To compare the effects of aggressive IVFR and rectal indomethacin (RI) in preventing pancreatitis after ERCP.

Material and methods

This is a double blind randomised controlled clinical trial on 186 patients undergoing ERCP in Ahvaz, Iran. The inclusion criteria were ERCP for standard clinical indications such as choledocholithiasis, bile duct leak, and biliary obstruction. The IVFR group (n = 62) received a bolus of 20 ml/kg of body weight lactated Ringer's solution (LRS) immediately after ERCP, followed by 3 ml/kg/h maintenance for 8 h. The RI group (n = 62) received 50 mg rectal indomethacin immediately before procedure and 12 h after ERCP. The control group (n = 62) did not receive any treatment.

Results

Post-ERCP pancreatitis in IVFR, rectal indomethacin, and control groups occurred in 8 (12.9%), 16 (25.8%), and 20 (32.3%) patients (p = 0.036). Pancreatic pain was reported in 13 (21%), 21 (33.9%), and 27 (43.5%) patients in the IVFR, RI, and control group (p = 0.046). The serum amylase level increased over 24 h after intervention in all three groups. The mean serum amylase level 8 h after intervention in the IVFR patients was lower than the RI and control groups.

Conclusions

Intravenous fluid resuscitation with LRS was more effective in preventing post-ERCP pancreatitis in comparison to the rectal indomethacin and control group.

Authors+Show Affiliations

Research Center for Infectious Diseases of Digestive System, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.David Geffen School of Medicine at UCLA, University, Los Angeles, California, USA.Research Center for Infectious Diseases of Digestive System, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29358996

Citation

Masjedizadeh, Abdolrahim, et al. "Comparative Effectiveness of Aggressive Intravenous Fluid Resuscitation With Lactated Ringer's Solution and Rectal Indomethacin Therapy in the Prevention of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography: a Double Blind Randomised Controlled Clinical Trial." Przeglad Gastroenterologiczny, vol. 12, no. 4, 2017, pp. 271-276.
Masjedizadeh A, Fathizadeh P, Aghamohamadi N. Comparative effectiveness of aggressive intravenous fluid resuscitation with lactated Ringer's solution and rectal indomethacin therapy in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: a double blind randomised controlled clinical trial. Prz Gastroenterol. 2017;12(4):271-276.
Masjedizadeh, A., Fathizadeh, P., & Aghamohamadi, N. (2017). Comparative effectiveness of aggressive intravenous fluid resuscitation with lactated Ringer's solution and rectal indomethacin therapy in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: a double blind randomised controlled clinical trial. Przeglad Gastroenterologiczny, 12(4), pp. 271-276. doi:10.5114/pg.2017.72102.
Masjedizadeh A, Fathizadeh P, Aghamohamadi N. Comparative Effectiveness of Aggressive Intravenous Fluid Resuscitation With Lactated Ringer's Solution and Rectal Indomethacin Therapy in the Prevention of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography: a Double Blind Randomised Controlled Clinical Trial. Prz Gastroenterol. 2017;12(4):271-276. PubMed PMID: 29358996.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative effectiveness of aggressive intravenous fluid resuscitation with lactated Ringer's solution and rectal indomethacin therapy in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: a double blind randomised controlled clinical trial. AU - Masjedizadeh,Abdolrahim, AU - Fathizadeh,Payman, AU - Aghamohamadi,Nima, Y1 - 2017/12/14/ PY - 2016/07/13/received PY - 2016/09/27/accepted PY - 2018/1/24/entrez PY - 2018/1/24/pubmed PY - 2018/1/24/medline KW - cholangiopancreatography KW - endoscopy KW - indomethacin KW - inflammation KW - pancreatitis SP - 271 EP - 276 JF - Przeglad gastroenterologiczny JO - Prz Gastroenterol VL - 12 IS - 4 N2 - Introduction: There is growing evidence indicating the aggressive intravenous fluid resuscitation (IVFR) can decrease the rate of pancreatitis; however, to the best of our knowledge it has not been well studied in a post-endoscopic retrograde cholangiopancreatography (post-ERCP) setting. Aim: To compare the effects of aggressive IVFR and rectal indomethacin (RI) in preventing pancreatitis after ERCP. Material and methods: This is a double blind randomised controlled clinical trial on 186 patients undergoing ERCP in Ahvaz, Iran. The inclusion criteria were ERCP for standard clinical indications such as choledocholithiasis, bile duct leak, and biliary obstruction. The IVFR group (n = 62) received a bolus of 20 ml/kg of body weight lactated Ringer's solution (LRS) immediately after ERCP, followed by 3 ml/kg/h maintenance for 8 h. The RI group (n = 62) received 50 mg rectal indomethacin immediately before procedure and 12 h after ERCP. The control group (n = 62) did not receive any treatment. Results: Post-ERCP pancreatitis in IVFR, rectal indomethacin, and control groups occurred in 8 (12.9%), 16 (25.8%), and 20 (32.3%) patients (p = 0.036). Pancreatic pain was reported in 13 (21%), 21 (33.9%), and 27 (43.5%) patients in the IVFR, RI, and control group (p = 0.046). The serum amylase level increased over 24 h after intervention in all three groups. The mean serum amylase level 8 h after intervention in the IVFR patients was lower than the RI and control groups. Conclusions: Intravenous fluid resuscitation with LRS was more effective in preventing post-ERCP pancreatitis in comparison to the rectal indomethacin and control group. SN - 1895-5770 UR - https://www.unboundmedicine.com/medline/citation/29358996/Comparative_effectiveness_of_aggressive_intravenous_fluid_resuscitation_with_lactated_Ringer's_solution_and_rectal_indomethacin_therapy_in_the_prevention_of_pancreatitis_after_endoscopic_retrograde_cholangiopancreatography:_a_double_blind_randomised_controlled_clinical_trial_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/29358996/ DB - PRIME DP - Unbound Medicine ER -