EFFICACY OF AGGRESSIVE PERIPROCEDURAL HYDRATION IN THE PREVENTION OF POST-ERCP PANCREATITIS: AN OBSERVATIONAL STUDY

Aims Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication of ERCP. Aggressive periprocedural hydration (APH) in addition to rectal administration of NSAIDs has been proposed to further reduce incidence of PEP with discordant results. We aimed to evaluate the added value of APH in reducing incidence of PEP in patients undergoing ERCP.

Methods We prospectively evaluated all consecutive patients undergoing ERCP in our center between 2019 and 2021. All patients received administration of rectal NSAIDs. According to the admission ward, (Gastroenterology versus Surgery) patients would undergo APH or normal hydration, respectively. Anthropometric, clinical and procedural characteristics were collected. Procedures were categorized in high- and low-risk of PEP (ESGE guidelines). Multivariate analysis for factors affecting the risk of PEP were calculated.

Results In the study period 117 patients, 55 females (47%), mean age 72.3(±13.8) years, were included. Indications for ERCP were common-bile-duct stones (85/117, 72%), pancreatic adenocarcinoma (13/117, 11%) and benign biliary strictures (12/117, 10%). Overall, 74/117 (63.2%) patients received APH, and 87/117 (74.3%) procedures were defined as high-risk. Of these, 56/87 (64%) received APH. Overall, 5/117 PEP were observed (5/5 mild severity-Atlanta criteria), 2/74 (2.7%) in APH group and 3/43 (7%) in normal-hydration group. At multivariate analysis, APH was not associated to lower incidence of PEP (OR 0.37 95%CI 0.1-2.3), while high-risk procedures (OR 7.4 95%CI 1.2–69.3) were associated to increased risk.

Conclusions APH did not result in a further reduction of PEP risk. Known risk-factors for difficult procedures were associated to increased risk of PEP.

Publication History

Article published online:
14 April 2022