Endoscopy 2018; 50(04): S25-S26
DOI: 10.1055/s-0038-1637102
ESGE Days 2018 oral presentations
20.04.2018 – ERCP 1: cannulation and adverse effects
Georg Thieme Verlag KG Stuttgart · New York

AGGRESSIVE INTRAVENOUS HYDRATION WITH LACTATED RINGER'S SOLUTION REDUCES THE DEVELOPMENT OF POST-ERCP PANCREATITIS

M Alcivar-Leon
1   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
,
A Serrano-Suarez
1   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
,
J Carrillo-Ubidia
1   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
,
ML Jara Alba
1   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
,
D Marriott-Blum
2   UESS, Guayaquil, Ecuador
,
L Frugone-Morla
3   Hospital Clinica Kennedy, Gastroenterology, Guayaquil, Ecuador
,
I Nieto-Orellana
4   Instituto Oncologico Nacional Solca, Gastroenterology, Guayaquil, Ecuador
,
K Mönkemüller
5   Frankenwald Klinik, Gastroenterology, Kronach, Germany
,
E Marriott-Diaz
1   Hospital IESS Teodoro Maldonado Carbo, Gastroenterology, Guayaquil, Ecuador
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Aims:

To determine whether aggressive periprocedural hydration with lactated Ringer's solution reduces the incidence of post-ERCP pancreatitis (PEP).

Methods:

Prospective, multicenter, randomized study in 652 patients who underwent first-time ERCP at three centers in Guayaquil, Ecuador (IESS – SOLCA – KENNEDY) from October 2013 to May 2017. The patients were randomly assigned to groups (1:1) that received vigorous hydration with lactated Ringer's solution (3 mL/kg/h during the procedure, a 20-mL/kg bolus after the procedure, and 3 mL/kg/h for 8 hours after the procedure) or standard hydration with saline solution (1.5 mL/kg/h during and for 8 hours after procedure). Serum levels of amylase, visual analogue pain scores (scale of 0 – 10), and volume overload were assessed at baseline and scale (VAS) 2, 8, and 24 hours after ERCP.

The primary end-point, PEP, was defined as hyperamylasemia (amylase > 3 times upper limit of normal) and epigastric pain (‡3 points on VAS) persisting for ‡24 hours after the procedure. Secondary end points included hyperamylasemia, increased pain, and volume overload.

Results:

The main indications for ERCP were choledocholithiasis (52%) and malignant biliary stricture (22%). PEP developed in 11 patients (3.4%) in the aggressive hydration with lactated Ringer's solution group and 28 patients (8.7%) in the hydration with saline solution (relative risk, 0.41; 95% CI, 0.20 – 0.86; P= 0.016). Moderate or severe acute pancreatitis occurred in a significantly smaller proportion of patients in the hydration with lactated Ringer's solution group (0.4%) than hydration with the saline solution group (2.0%; P= 0.040).

Hyperamylasemia developed in 21% of patients who received aggressive hydration vs. 37% of those who received standard hydration (P = 0.116). No patients had clinical evidence of volume overload.

Conclusions:

We found that aggressive intravenous hydration with lactated Ringer's solution appeared to reduce the development of PEP and was not associated with volume overload.