Role of Prophylactic Aggressive Hydration to Prevent Post-endoscopic Retrograde Cholangiopancreatography...

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is one of the important procedure-related complications of ERCP. Periprocedural intravenous hydration with lactated Ringer's solution has been considered a simple and feasible measure for reducing this complication. The present trial was designed to assess whether aggressive hydration with lactated Ringer's solution was more effective than standard hydration in preventing post-ERCP pancreatitis (PEP).

This randomized controlled trial was performed at two tertiary care hospitals. A total of 126 patients undergoing first-time ERCP were included and randomly distributed into two equal treatment groups. Patients in group A were managed with standard hydration, whereas patients in group B received aggressive hydration using lactated Ringer's solution. The main outcome measure was the development of PEP. Other recorded outcomes were post-ERCP hyperamylasemia, isolated hyperamylasemia, serial pain scores on the visual analog scale, serum amylase levels, duration of hospital stay, and fluid-related adverse effects.

All 126 randomized patients completed the 24-hour assessment. PEP developed in 14 patients in the standard hydration arm and four patients in the aggressive hydration arm (22.2% versus 6.3%; p = 0.020; RR = 0.29, 95% CI = 0.10-0.82). Total post-ERCP hyperamylasemia was less frequent after aggressive hydration than standard hydration (14.3% versus 41.3%; p = 0.001). Isolated hyperamylasemia was recorded in 7.9% and 19.0% of patients, respectively (p = 0.116). Pain scores remained lower with aggressive hydration at 4, 12, and 24 hours (all p < 0.001). Hospital stay was also reduced (1.8 versus 3.0 days; p < 0.001).

Aggressive hydration with lactated Ringer's solution significantly reduced PEP, post-procedure hyperamylasemia, pain scores, and hospital stay compared with standard hydration. The regimen was well tolerated in selected patients without fluid-overload risk.