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Peri-Procedural Aggressive Hydration for Post Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis Prophylaxsis: Meta-analysis of Randomized Controlled Trials.
Pancreatology. 2019 Sep; 19(6):819-827.P

Abstract

BACKGROUND

Periprocedural 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.

METHODS

Pubmed, 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.

RESULTS

A 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.

CONCLUSION

Aggressive 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.

Authors+Show Affiliations

Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA. Electronic address: Dhruvil.Radadiya3@gmail.com.Division of Gastroenterology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA.Division of Gastroenterology, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.Division of Gastroenterology, Department of Internal Medicine, Saint Peter's University Hospital/Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.Division of Gastroenterology, Department of Internal Medicine, Mayo Clinic, Florida, USA.Division of Gastroenterology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA.Division of Gastroenterology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

31383573

Citation

Radadiya, Dhruvil, et al. "Peri-Procedural Aggressive Hydration for Post Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis Prophylaxsis: Meta-analysis of Randomized Controlled Trials." Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], vol. 19, no. 6, 2019, pp. 819-827.
Radadiya D, Devani K, Arora S, et al. Peri-Procedural Aggressive Hydration for Post Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis Prophylaxsis: Meta-analysis of Randomized Controlled Trials. Pancreatology. 2019;19(6):819-827.
Radadiya, D., Devani, K., Arora, S., Charilaou, P., Brahmbhatt, B., Young, M., & Reddy, C. (2019). Peri-Procedural Aggressive Hydration for Post Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis Prophylaxsis: Meta-analysis of Randomized Controlled Trials. Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.], 19(6), 819-827. https://doi.org/10.1016/j.pan.2019.07.046
Radadiya D, et al. Peri-Procedural Aggressive Hydration for Post Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis Prophylaxsis: Meta-analysis of Randomized Controlled Trials. Pancreatology. 2019;19(6):819-827. PubMed PMID: 31383573.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Peri-Procedural Aggressive Hydration for Post Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis Prophylaxsis: Meta-analysis of Randomized Controlled Trials. AU - Radadiya,Dhruvil, AU - Devani,Kalpit, AU - Arora,Sumant, AU - Charilaou,Paris, AU - Brahmbhatt,Bhaumik, AU - Young,Mark, AU - Reddy,Chakradhar, Y1 - 2019/07/30/ PY - 2019/04/06/received PY - 2019/06/28/revised PY - 2019/07/29/accepted PY - 2019/8/7/pubmed PY - 2020/2/25/medline PY - 2019/8/7/entrez KW - Abdominal pain KW - Adverse events KW - Normal saline KW - Prevention KW - Ringer's lactate SP - 819 EP - 827 JF - Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] JO - Pancreatology VL - 19 IS - 6 N2 - BACKGROUND: Periprocedural 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. METHODS: Pubmed, 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. RESULTS: A 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. CONCLUSION: Aggressive 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. SN - 1424-3911 UR - https://www.unboundmedicine.com/medline/citation/31383573/Peri_Procedural_Aggressive_Hydration_for_Post_Endoscopic_Retrograde_Cholangiopancreatography__ERCP__Pancreatitis_Prophylaxsis:_Meta_analysis_of_Randomized_Controlled_Trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1424-3903(19)30680-5 DB - PRIME DP - Unbound Medicine ER -