Arunchai Chang1,2, Nonthalee Pausawasdi3,4,5, Phunchai Charatcharoenwitthaya1,6, Uayporn Kaosombatwattana1,6, Tassanee Sriprayoon1, Julajak Limsrivilai1,6, Varayu Prachayakul1,6, Somchai Leelakusolvong1,6. 1. Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 2. Division of Gastroenterology, Department of Medicine, Hatyai Hospital, Songkla, Thailand. 3. Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. nonthaleep7@gmail.com. 4. Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. nonthaleep7@gmail.com. 5. Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Wang-Lang Road, Bangkoknoi, Bangkok, 10700, Thailand. nonthaleep7@gmail.com. 6. Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Abstract
BACKGROUND: Aggressive intravenous fluid hydration, by administering 3500 mL of lactated Ringer's solution (LRS) in 9 h with a peri-procedural bolus, reduces post-ERCP pancreatitis (PEP) incidence. A concern of this strategy is adverse events related to volume overload; however, the impact of fluid hydration over an extended period without a bolus on PEP is unknown. AIM: To assess the effect of continuous infusion of high-volume fluid at a constant rate over 24 h on PEP incidence and severity. METHODS: Two-hundred patients were randomly assigned (1:1) to receive either 3600 mL of LRS in 24 h starting 2 h before the ERCP (high-volume group) or maintenance fluid hydration calculated by the Holliday-Segar method (control group). RESULTS: The mean age of the patients was 50.6 ± 11.6 years. The predominant indications were choledocholithiasis (48%) and malignancies (32%). Patient demographics and PEP risk factors were similar in both groups. Patients in the high-volume group received significantly more fluid than the control group (3600 vs. 2413 ml, P < 0.001). PEP incidence was not different between the high-volume and the control group (14% vs. 15%; relative risk 0.93: 95% CI 0.48-1.83, P = 0.84). There were no differences in moderate to severe PEP (3% vs. 4%; relative risk 0.75: 95% CI, 0.17-3.27, P = 1.00). Subgroup analysis did not show a benefit in high-risk patients. Only one patient in the control group developed peripheral edema. CONCLUSIONS: An infusion of high-volume hydration over 24 h is not sufficient to provide optimal hydration for PEP prevention. CLINICAL TRIAL REGISTRY NUMBER: No. NCT02821546.
BACKGROUND: Aggressive intravenous fluid hydration, by administering 3500 mL of lactated Ringer's solution (LRS) in 9 h with a peri-procedural bolus, reduces post-ERCP pancreatitis (PEP) incidence. A concern of this strategy is adverse events related to volume overload; however, the impact of fluid hydration over an extended period without a bolus on PEP is unknown. AIM: To assess the effect of continuous infusion of high-volume fluid at a constant rate over 24 h on PEP incidence and severity. METHODS: Two-hundred patients were randomly assigned (1:1) to receive either 3600 mL of LRS in 24 h starting 2 h before the ERCP (high-volume group) or maintenance fluid hydration calculated by the Holliday-Segar method (control group). RESULTS: The mean age of the patients was 50.6 ± 11.6 years. The predominant indications were choledocholithiasis (48%) and malignancies (32%). Patient demographics and PEP risk factors were similar in both groups. Patients in the high-volume group received significantly more fluid than the control group (3600 vs. 2413 ml, P < 0.001). PEP incidence was not different between the high-volume and the control group (14% vs. 15%; relative risk 0.93: 95% CI 0.48-1.83, P = 0.84). There were no differences in moderate to severe PEP (3% vs. 4%; relative risk 0.75: 95% CI, 0.17-3.27, P = 1.00). Subgroup analysis did not show a benefit in high-risk patients. Only one patient in the control group developed peripheral edema. CONCLUSIONS: An infusion of high-volume hydration over 24 h is not sufficient to provide optimal hydration for PEP prevention. CLINICAL TRIAL REGISTRY NUMBER: No. NCT02821546.
Authors: Bechien U Wu; James Q Hwang; Timothy H Gardner; Kathryn Repas; Ryan Delee; Song Yu; Benjamin Smith; Peter A Banks; Darwin L Conwell Journal: Clin Gastroenterol Hepatol Date: 2011-05-12 Impact factor: 11.382