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Aggressive hydration with Lactated Ringer's solution as the prophylactic intervention for postendoscopic retrograde cholangiopancreatography pancreatitis: A randomized controlled double-blind clinical trial.

Shaygan-Nejad A, Masjedizadeh AR, Ghavidel A, Ghojazadeh M, Khoshbaten M - J Res Med Sci (2015)

Bottom Line: There is no effective prophylactic intervention for patients with average risk yet.Post-ERCP pancreatitis was defined as hyperamylasemia (level of amylase >300) and pancreatic pain during the 24 h follow-up.Aggressive hydration with lactated Ringer's solution may effectively prevent post-ERCP pancreatitis as well as hyperamylasemia and pancreatic pain in patients with average risk.

View Article: PubMed Central - PubMed

Affiliation: Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

ABSTRACT

Background: Pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) and may cause significant morbidity and even death. There is no effective prophylactic intervention for patients with average risk yet. This study aims to investigate preventive effect of aggressive hydration for post-ERCP pancreatitis.

Materials and methods: In a double-blind controlled setting, 150 patient were randomly assigned to receive either aggressive hydration with lactated Ringer's solution (3 mL/kg/h during ERCP, followed by a 20 mL/kg bolus and 3 mL/kg/h for 8 h after the procedure, n = 75) or standard amount of hydration (1.5 mL/kg/h during and for 8 h after ERCP, n = 75). Patients were observed for volume overload as well as pancreatic pain and serum levels of amylase at baseline and 2, 8, and 24 h after ERCP. Post-ERCP pancreatitis was defined as hyperamylasemia (level of amylase >300) and pancreatic pain during the 24 h follow-up. Hyperamylasemia and pancreatic pain were the secondary end points.

Results: Mean age of the patients was 50.8 ± 13.5 years. Most of the patients were female (66%). Pancreatitis developed in 21 patients, including 22.7% of patients receiving standard hydration and 5.3% patients receiving aggressive hydration (P = 0.002). Hyperamylasemia was detected in 44.0% of patients receiving standard hydration and 22.7% of patients aggressive hydration (P = 0.006). The pancreatic pain was reported by 5.3% of patients receiving aggressive hydration and 37.3% of patients receiving standard hydration (P ≤ 0.005).

Conclusion: Aggressive hydration with lactated Ringer's solution may effectively prevent post-ERCP pancreatitis as well as hyperamylasemia and pancreatic pain in patients with average risk.

No MeSH data available.


Related in: MedlinePlus

Mean level of pain reported by patients in 2, 8 and 24 h postendoscopic retrograde cholangiopancreatography
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Figure 2: Mean level of pain reported by patients in 2, 8 and 24 h postendoscopic retrograde cholangiopancreatography

Mentions: Pancreatic pain (pain scoring 3 or more on VAS) was reported by four patients (5.3%) receiving aggressive hydration and 28 patients (37.3%) receiving standard hydration (P ≤ 0.005). A repeated measurement analysis showed a significant effect for the type of intervention (F(1.148) = 25.001, P < 0.001, power = 80%) and the reported pain score also significantly decreased in both groups (F(2,72) = 28.610, P < 0.005, power = 80%). The time-group interaction was also significant (F(1.148) = 8.885, P = 0.003, power = 80%). These are illustrated in Figure 2.


Aggressive hydration with Lactated Ringer's solution as the prophylactic intervention for postendoscopic retrograde cholangiopancreatography pancreatitis: A randomized controlled double-blind clinical trial.

Shaygan-Nejad A, Masjedizadeh AR, Ghavidel A, Ghojazadeh M, Khoshbaten M - J Res Med Sci (2015)

Mean level of pain reported by patients in 2, 8 and 24 h postendoscopic retrograde cholangiopancreatography
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4696367&req=5

Figure 2: Mean level of pain reported by patients in 2, 8 and 24 h postendoscopic retrograde cholangiopancreatography
Mentions: Pancreatic pain (pain scoring 3 or more on VAS) was reported by four patients (5.3%) receiving aggressive hydration and 28 patients (37.3%) receiving standard hydration (P ≤ 0.005). A repeated measurement analysis showed a significant effect for the type of intervention (F(1.148) = 25.001, P < 0.001, power = 80%) and the reported pain score also significantly decreased in both groups (F(2,72) = 28.610, P < 0.005, power = 80%). The time-group interaction was also significant (F(1.148) = 8.885, P = 0.003, power = 80%). These are illustrated in Figure 2.

Bottom Line: There is no effective prophylactic intervention for patients with average risk yet.Post-ERCP pancreatitis was defined as hyperamylasemia (level of amylase >300) and pancreatic pain during the 24 h follow-up.Aggressive hydration with lactated Ringer's solution may effectively prevent post-ERCP pancreatitis as well as hyperamylasemia and pancreatic pain in patients with average risk.

View Article: PubMed Central - PubMed

Affiliation: Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

ABSTRACT

Background: Pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP) and may cause significant morbidity and even death. There is no effective prophylactic intervention for patients with average risk yet. This study aims to investigate preventive effect of aggressive hydration for post-ERCP pancreatitis.

Materials and methods: In a double-blind controlled setting, 150 patient were randomly assigned to receive either aggressive hydration with lactated Ringer's solution (3 mL/kg/h during ERCP, followed by a 20 mL/kg bolus and 3 mL/kg/h for 8 h after the procedure, n = 75) or standard amount of hydration (1.5 mL/kg/h during and for 8 h after ERCP, n = 75). Patients were observed for volume overload as well as pancreatic pain and serum levels of amylase at baseline and 2, 8, and 24 h after ERCP. Post-ERCP pancreatitis was defined as hyperamylasemia (level of amylase >300) and pancreatic pain during the 24 h follow-up. Hyperamylasemia and pancreatic pain were the secondary end points.

Results: Mean age of the patients was 50.8 ± 13.5 years. Most of the patients were female (66%). Pancreatitis developed in 21 patients, including 22.7% of patients receiving standard hydration and 5.3% patients receiving aggressive hydration (P = 0.002). Hyperamylasemia was detected in 44.0% of patients receiving standard hydration and 22.7% of patients aggressive hydration (P = 0.006). The pancreatic pain was reported by 5.3% of patients receiving aggressive hydration and 37.3% of patients receiving standard hydration (P ≤ 0.005).

Conclusion: Aggressive hydration with lactated Ringer's solution may effectively prevent post-ERCP pancreatitis as well as hyperamylasemia and pancreatic pain in patients with average risk.

No MeSH data available.


Related in: MedlinePlus