Fluid type and volume reduce risk of post-ERCP pancreatitis and length of hospital stay in high-risk patients: a secondary analysis of the INDIEH trial*

• Main Authors: Rupjyoti Talukdar, Ayesha Kamal, Venkata S. Akshintala, Rajesh Goud, Sundeep Lakhtakia, Mohan K. Ramchandani, Manu Tandan, G. V. Rao, Zaheer Nabi, Rajesh Gupta, Rakesh Kalapala, Jahangeer Basha, Manohar Reddy, Vijay K. Rai, Mahesh K Goenka, Saroj Sinha, Rakesh Kochhar, B. Joseph Elmunzer, Mouen A. Khashab, Anthony N. Kalloo, Vikesh K. Singh, D. Nageshwar Reddy
• Format: Article
• Language: English
• Published: Georg Thieme Verlag KG 2020-06-01
• Series: Endoscopy International Open
• Online Access: http://www.thieme-connect.de/DOI/DOI?10.1055/a-1149-1359
• ISSN: 2364-3722; 2196-9736

Background and study aims Impact of intravenous fluid administration on prophylaxis against post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) has not been rigorously evaluated among patients at high-risk for PEP. Patients and methods Effect of volume and type of fluid administered on PEP incidence was studied through a secondary analysis of high-risk patients who underwent endoscopic retrograde cholangopancreatography (ERCP) as a part of a randomized controlled trial in which all patients received rectal indomethacin. Periprocedural fluid was defined as fluid infused during and after ERCP. Results A total 960 patients were randomized during the trial, of whom 476 (49.6 %) received periprocedural fluids (mean volume = 1245 mL [± 629]). There was a trend towards a lower incidence of PEP in patients who received periprocedural fluid vs. those who did not (5.2 % vs. 8.0 %, P = 0.079). Among those receiving fluids, those who did not develop PEP received a higher mean volume of fluid vs. who developed PEP (1012 ± 725 mL vs. 752 ± 783 mL, P = 0.036). Among 174 patients (37 %) who received LR, patients who did not develop PEP received a higher mean volume of LR vs. those who developed PEP (570 ± 559 mL vs. 329 ± 356 mL, P = 0.006). Length of hospital stay decreased as the volume of periprocedural volume administration increased (r = 0.16, P < 0.001). Conclusion Higher fluid volume and lactated Ringerʼs use during the periprocedural period was associated with a decreased risk of PEP and length of hospital stay beyond rectal indomethacin in high risk patients.