The Role of Intravenous Hydration in the Prevention of PostEndoscopic Retrograde Cholangiopancreatography Pancreatitis

Objective: Pancreatitis is the most frequently observed complication after endoscopic retrograde cholangiopancreatography. Several preventive methods for post-endoscopic retrograde cholangiopancreatography pancreatitis have been developed. A pilot study was conducted to determine whether aggressive periprocedural hydration with lactated Ringer’s solution reduces the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis.

Methods: The study included 32 patients who required endoscopic retrograde cholangiopancreatography for diagnostic or therapeutic purposes. Patients were randomized (1 : 1) to receive either aggressive hydration with lactated Ringer’s solution (n=16) or standard hydration with the same solution (n=16). Oral intake was stopped after midnight and endoscopic retrograde cholangiopancreatography began at 10:00 am. Hourly fluid requirements of patients in the aggressive hydration group were calculated based on the 4-2-1 formula (4 mL/kg/h for the first 10 kg, 2 mL/kg/h for the next 10 kg, and 1 mL/kg/h thereafter) and fluid requirements of 10 hours were met in 2 hours from 08:00 to 10:00 am before endoscopic retrograde cholangiopancreatography. At the 4th and 24th hours following endoscopic retrograde cholangiopancreatography, serum amylase and lipase levels, volume overload, and other complications were assessed. Acute pancreatitis was defined and ranked in accordance with the 2012 Atlanta Classification criteria.

Results: Of all patients, 34% (11/32) developed pancreatitis after endoscopic retrograde cholangiopancreatography, compared with 12.5% (2/16) in the aggressive hydration group and 56.3% (9/16) in the standard hydration group. Pancreatitis was significantly less prevalent in the aggressive hydration group (P=.009). All observed cases of pancreatitis were mild.

Conclusion: According to this pilot study, aggressive hydration with lactated Ringer's solution reduces the risk of post-endoscopic retrograde cholangiopancre atography pancreatitis.

Cite this article as: Kırmızıer G, Yaras S, Üçbilek E, et al. The role of intravenous hydration in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Diagn Interv Endosc. 2023;2(1):9-13.