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Systematic review: periprocedural hydration in the prevention of post‐ ERCP pancreatitis
Author(s) -
Smeets X. J. N. M.,
Costa D. W.,
Besselink M. G.,
Bruno M. J.,
Fockens P.,
Mulder C. J. J.,
Hulst R. W.,
Vleggaar F. P.,
Timmer R.,
Drenth J. P. H.,
Geenen E. J. M.
Publication year - 2016
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13744
Subject(s) - medicine , pancreatitis , medline , intensive care medicine , general surgery , gastroenterology , law , political science
Summary Background With an overall incidence of 3.5%, pancreatitis is the most frequent complication of endoscopic retrograde cholangiopancreatography ( ERCP ). Periprocedural hydration may prevent post‐ ERCP pancreatitis by maintaining pancreatic microperfusion, thereby inhibiting the pancreatic inflammatory response. However, the evidence for periprocedural hydration as a preventive measure is unclear. Aim To conduct a systematic review to assess the evidence regarding periprocedural hydration as a preventive measure for post‐ ERCP pancreatitis. Methods We searched PubMed and EMBASE databases and adhered to the PRISMA guidelines. We included studies addressing periprocedural hydration as a preventive measure to reduce frequency and severity of post‐ ERCP pancreatitis. Study quality was assessed by using the MINORS and Cochrane Collaboration's tool. Results Six studies with a total of 1102 patients were included. Two randomised controlled trials reported a decreased incidence of post‐ ERCP pancreatitis after hydration: 0% vs. 17% ( P = 0.016) and 5.3% vs. 22.7% ( P = 0.002). A third trial and two case–controls studies did not report significant differences. Two retrospective studies found that patients with mild post‐ ERCP pancreatitis had received significantly more fluids during (mean 940 mL vs. 810 mL; P = 0.031) or after ERCP (median 2834 mL vs. 2044 mL; P < 0.02) compared to patients with moderate/severe disease. Adverse events of periprocedural hydration were not reported in any of the included studies. The different methodologies of the included studies precluded a formal data synthesis. Conclusions There is some evidence to suggest that hydration affords protection against post‐ ERCP pancreatitis, but study heterogeneity precludes firm conclusions. Adequately powered randomised trials are needed to evaluate the preventive effect of periprocedural hydration.