AGGRESSIVE HYDRATION FOR PREVENTING POST ERCP PANCREATITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Aims Periprocedural intravenous hydration is suggested to decrease the risk of post-ERCP pancreatitis (PEP). However, quality of evidence remains poor. We performed a systematic review with meta-analysis to assess the hypothesis that aggressive hydration(AH) could be an effective preventive measure.

Methods Pubmed, EMBASE-, Google Scholar, 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. Outcomes were incidence of PEP, incidence of Hyperamylasemia, incidence of abdominal pain, adverse event rate, and length of stay

Results A total of 9 RCTs (5 full text and 4 abstract), with 2094 patients, were included. AH had a lower incidence of PEP compared with SH (OR 0.44 95%CI 0.28-0.69). The rate of post ERCP hyperamylasemia was lower in the AH group (OR 0,.51 95%CI 0.34-0.77) and length of stay was reduced in the AH group (MD −0.89 −1.36-, −0.43) .No significant difference emerged in adverse events related to fluid overload between two groups (OR:1.29; p 1⁄4 0.81) and post- ERCP abdominal pain (OR:0.35; p 1⁄4 0.17). Numbers of patient to be treated with AH to prevent one episode of PEP was 17.

Conclusions 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.