Lactated Ringer's Solution at a Standard Infusion Rate in Post-endoscopic Retrograde Cholangiopancreatography...

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is a common complication, and its prevention remains challenging. Although aggressive infusion of lactated Ringer's solution (hereafter Lactated Ringer's) has shown preventive effects, the efficacy of standard infusion rates remains unclear.

To evaluate whether lactated Ringer's administered at a standard rate reduces the incidence or severity of post-ERCP pancreatitis compared with non-lactated Ringer's solutions.

This single-center retrospective study compared patients who received non-lactated Ringer's solutions before January 2019 with those who received lactated Ringer's after January 2019, at a standard rate. The outcomes were post-ERCP pancreatitis incidence, severity, C-reactive protein (CRP) level, and systemic inflammatory response syndrome (SIRS).

Of 1194 patients included (median age, 71 years; 60% male), pancreatitis occurred in 5.6% (30/529) of the non-lactated Ringer's group and 5.3% (35/665) of the lactated Ringer's group (P = 0.76). Severe or moderately severe pancreatitis occurred in six patients each in both groups (approximately 1%). Mean CRP level at 24 h was similar between the groups (1.26 vs. 1.44 mg/dL, P = 0.75), and SIRS rates at 24/48 h did not differ significantly (P = 0.61 and 1.00). Multivariate analysis identified pancreatic injection, naïve papilla, and female sex as independent risk factors; fluid type was not associated with outcome (OR 1.09, P = 0.76).

Lactated Ringer's at a standard infusion rate did not reduce the incidence or severity of post-ERCP pancreatitis compared with a non-lactated Ringer's solution. Further research is required to optimize fluid therapy for preventing this complication.