Hemodynamic Variation and Intravenous Fluids Administered During ERCP and the Association With Post-ERCP Pancreatitis

We sought to determine whether hypotension and the amount of intravenous (IV) fluids administered during endoscopic retrograde cholangiopancreatography (ERCP) were associated with post-ERCP pancreatitis.

We identified patients who developed post-ERCP pancreatitis between 2009 and 2013. Using a case-control design, we extracted baseline and intra-ERCP vital signs and the amount of IV fluids given. We used regression to analyze the association between these factors and the risk of post-ERCP pancreatitis.

We found no association between intraprocedure hypotension (P = 0.17), bradycardia (P = 0.20), hypoxemia (P = 1.0), dehydration (P = 0.80), and post-ERCP pancreatitis. An increase in mean arterial pressure (MAP) more than 20 units from baseline (odds ratio [OR], 1.8; P = 0.03), increasing amount of IV fluids administered during ERCP (OR, 1.5; P = 0.03), female sex (OR, 2.6; P = 0.001), and younger age (OR, 1.02; P = 0.01) were associated with post-ERCP pancreatitis. In multivariate regression, female sex maintained statistical significance (P = 0.01); MAP more than 20 units from baseline (P = 0.1) and increased IV fluids (P = 0.09) showed an insignificant trend.

Hypotension during ERCP was not associated with post-ERCP pancreatitis. An increase in MAP more than 20 units from baseline and an increase in the amount of IV fluids administered during ERCP may increase the risk of post-ERCP pancreatitis.