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Published on: September 20, 2019
Safety and efficacy of early feeding based on clinical assessment at 4 hours after ERCP: a prospective
Chan Hyuk Park1, Jang Han Jung2, Bomi Hyun2
1Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Gyeonggi-do, Republic of Korea.
Insights
Early refeeding after ERCP, guided by clinical assessment and amylase levels, is safe and reduces costs. Patients can resume eating 4 hours post-procedure without increasing post-ERCP pancreatitis risk.
Area of Science:
- Gastroenterology
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Pancreatitis
Background:
- The optimal timing for resuming oral intake following ERCP remains uncertain.
- Current practices vary, with some institutions advocating for a 24-hour fasting period post-ERCP, while others permit earlier refeeding.
Purpose of the Study:
- To assess the risk of post-ERCP pancreatitis (PEP) in patients who undergo early refeeding.
- To evaluate the safety and efficacy of initiating oral intake 4 hours after ERCP based on clinical parameters and serum amylase levels.
Main Methods:
- A randomized controlled trial involving patients undergoing ERCP.
- Patients were stratified based on absence of abdominal pain/tenderness and serum amylase levels (<1.5x upper limit of normal) at 4 hours post-ERCP.
- Participants were randomized to either a 4-hour or 24-hour fasting group before resuming oral intake.
Main Results:
- No significant difference in PEP incidence was observed between the 4-hour fasting group (2.2%) and the 24-hour fasting group (3.6%).
- Early refeeding (4-hour group) was found to be non-inferior to prolonged fasting (24-hour group) regarding PEP rates.
- Total medical costs associated with ERCP were significantly lower in the early refeeding group.
Conclusions:
- Initiating early oral feeding 4 hours after ERCP in selected patients (asymptomatic with normal amylase) does not elevate the risk of PEP.
- Early refeeding is associated with reduced medical costs, suggesting a more efficient patient management strategy.
Background And Aims:
The optimal timing of refeeding after ERCP is unknown. Some practices keep the patient fasting for 24 hours after ERCP, whereas others resume feeding earlier. We aimed to evaluate the risk of post-ERCP pancreatitis (PEP) in patients who initiate early feeding, based on their clinical assessment, including serum amylase testing performed at 4 hours after ERCP.
Methods:
Patients who were scheduled for ERCP were recruited. Patients without abdominal pain and tenderness and a serum amylase level within 1.5-fold the upper limit of normal at 4 hours after ERCP were randomly assigned to either the 4-hour fasting or 24-hour fasting group. Patients from the 4-hour fasting group started oral intake 4 hours after ERCP, whereas those from the 24-hour fasting group fasted for 24 hours after ERCP.
Results:
Among the 276 enrolled, PEP was identified in 3 (2.2%) from the 4-hour fasting group and in 5 (3.6%) from the 24-hour fasting group, with a rate difference of -1.4% (1-sided 97.5% confidence interval, -∞ to 2.5%). Four-hour fasting was non-inferior to 24-hour fasting in terms of PEP incidence. The total medical costs for treatment-related ERCP were significantly lower in the 4-hour fasting group than in the 24-hour fasting group (1157.20 ± 311.90 vs 1311.20 ± 410.70 U.S. dollars; P = .032).
Conclusion:
Early feeding in patients without abdominal pain and tenderness and a serum amylase level <1.5-fold the upper limit of normal at 4 hours after ERCP does not increase the incidence of PEP after ERCP and decreases medical costs. (Clinical trial registration number: KCT0002354.).
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