Abstract
AGGRESSIVE HYDRATION WITH LACTATED RINGERS FOR REDUCING POST-ERCP PANCREATITIS: A SYSTEMATIC REVIEW AND META ANALYSIS
Uy, Tiffany Grace C., MD1,3 ; Pe Benito, Martin Emmanuel V., MD1; Masbang, Armin N., MD1, Porciuncula II, Vicente C., MD2
1St. Luke's Medical Center, Quezon City, Philippines
2Institute of Digestive and Liver Diseases, St. Luke's Medical Center, Quezon City, Philippines
3Corresponding author: Jose Gil Street, San Juan, NCR Philippines,
Background: The most common complication of Endoscopic Retrograde Cholangiopancreatography (ERCP) is post-ERCP Pancreatitis (PEP). Aggressive periprocedural hydration with PLR has been shown to reduce incidence of PEP, but the evidence is still lacking. This meta-analysis aims to determine if aggressive hydration with Lactated Ringer Solution reduces the incidence of PEP.
Methodology: RCTs studying the effect of aggressive PLR hydration on the incidence of PEP were retrieved from Pubmed, Cochrane and OVID databases using the following key terms and their equivalents: ERCP, pancreatitis, hydration. Nonrandomized studies and studies that included other interventions were excluded. Quality assessment was done using the Cochrane risk of bias tool. Pooled odds ratio (OR) at 95% confidence intervals were computed to generate forest plots. Data synthesis and analysis were performed using Revman 5.4 for Mac. A p-value <0.05 was considered as statistically significant.
Results: Six RCTs with 1516 patients were included in this meta-analysis. The incidence of PEP was significantly lower in the aggressive hydration group overall 5.6% (43/765) compared to 13.4% (101/751) in the standard (OR=0.37, CI= 0.23 - 0.60, P<0.0001, I2=34%). This effect was maintained regardless of timing of onset of hydration, with decreased risk of PEP seen in the aggressive hydration group, given hydration pre-procedure (OR =0.51, CI= 0.28 - 0.93, P=0.03, I2=41%) and those that only started hydration periprocedure (OR =0.22, CI= 0.11 - 0.44, P<0.00001, I2=0%).
Conclusion: Aggressive hydration with Lactated Ringer Solution in patients undergoing ERCP can prevent PEP.
Keywords: meta-analysis, endoscopic retrograde cholangiopancreatography, pancreatitis, hydration, Lactated Ringer Solution
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |