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Short-term intravenous fluids for prevention of post-ERCP pancreatitis (the STRIPE study): protocol for a five-arm
Nauzer Forbes1,2, Howard Guo3,2, Ashlee Kruk3
1Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada nauzer.forbes@ucalgary.ca.
Insights
Short-term intravenous fluid hydration protocols show promise in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The STRIPE study evaluates practical fluid regimens to reduce this common adverse event.
Area of Science:
- Gastroenterology
- Clinical Trials
- Patient Safety
Background:
- Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a frequent and serious complication.
- Prolonged intravenous (IV) fluid hydration is effective but impractical for outpatients.
- Limited data exists on shorter hydration protocols for PEP prevention.
Purpose of the Study:
- To evaluate the efficacy of short-term peri-procedural IV fluid regimens in mitigating PEP.
- To identify a practical hydration strategy for PEP prevention in diverse clinical settings.
Main Methods:
- A randomized controlled trial (STRIPE study) involving 505 participants.
- Five groups receiving varying volumes (500-2500 mL) of IV Ringer's lactate peri-procedurally.
- Primary outcome: serum amylase levels 24 hours post-ERCP; secondary outcomes: PEP incidence, adverse events.
Main Results:
- This section will be updated upon study completion and data analysis.
Conclusions:
- This section will be updated upon study completion and data analysis.
Introduction:
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a significant procedural adverse event (AE), occurring in 5-15% of cases and leading to substantial morbidity and mortality. Aggressive prolonged intravenous (IV) fluid regimens have demonstrated efficacy in reducing PEP in clinical trials. However, these regimens typically involve continuous infusion of IV fluids over 8-24 hours following ERCP, making them impractical for outpatient settings. Data on shorter hydration protocols are lacking. The STRIPE study aims to address this gap by evaluating short-term peri-procedural IV fluid regimens as a practical alternative for mitigating PEP.
Methods And Analysis:
This proof-of-concept, parallel-arm, randomised controlled trial will evaluate the impact of various short-term IV fluid regimens on post-ERCP serum amylase levels, a surrogate marker for PEP. Participants undergoing ERCP will be randomised into five groups, receiving 500 mL, 1000 mL, 1500 mL, 2000 mL or 2500 mL of IV Ringer's lactate during the peri-procedural period. Patients, endoscopists and outcome assessors will be blinded to treatment allocation during the peri-procedural period. The primary outcome is the serum amylase level 24 hours post-ERCP. Secondary outcomes include PEP, 30-day AEs and unplanned healthcare encounters including those related to volume overload or cardiovascular AEs, duration of hospitalisation (for inpatients), death within 30 days and other relevant laboratory markers at 24 hours. A total of 505 participants (101 in each arm) will be enrolled to ensure adequate power after accounting for attrition and/or sample loss.
Ethics And Dissemination:
This trial was registered on clinicaltrials.gov on 7 February 2024. The study was approved by the University of Calgary Conjoint Health Research Ethics Board (REB23-0625). On study completion, data will be made available on reasonable request to the corresponding author after completion of the study. Study dissemination and knowledge translation is planned via presentations at scholarly meetings, publications in peer-reviewed journals and, ideally, via adoption of results into clinical practice guidelines.
Trial Registration Number:
NCT06260878.
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