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Cited 41 time in webofscience Cited 43 time in scopus
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Aggressive intravenous hydration with lactated Ringer's solution for prevention of post-ERCP pancreatitis: a prospective randomized multicenter clinical trial

Authors
Park, Chang-HwanPaik, Woo HyunPark, Eun TaekShim, Chan SupLee, Tae YoonKang, ChangdonNoh, Myung HwanYi, Sun YounLee, Jong KyunHyun, Jong JinLee, Jun Kyu
Issue Date
Apr-2018
Publisher
Georg Thieme Verlag
Citation
Endoscopy, v.50, no.4, pp.378 - 385
Indexed
SCIE
SCOPUS
Journal Title
Endoscopy
Volume
50
Number
4
Start Page
378
End Page
385
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/3716
DOI
10.1055/s-0043-122386
ISSN
0013-726X
Abstract
Background and study aims  The present study aimed to determine the type of intravenous hydration that is best suited to reducing the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Patients and methods  In a prospective randomized multicenter trial, average-to-high risk patients who underwent first-time ERCP were randomly assigned to three groups (1:1:1) who received: aggressive intravenous hydration (3 mL/kg/h during ERCP, a 20-mL/kg bolus and 3 mL/kg/h for 8 hours after ERCP) with either lactated Ringer’s solution (LRS) or normal saline solution (NSS), or standard intravenous hydration with LRS (1.5 mL/kg/h during and for 8 hours after ERCP). The primary end point was post-ERCP pancreatitis (PEP). Results  395 patients were enrolled, and 385 completed the protocols. The three groups showed no significant differences in demographic characteristics. There was a significant difference in the intention-to-treat (ITT) PEP rate between the aggressive LRS group (3.0 %, 95 % confidence interval [CI] 0.1 % – 5.9 %; 4 /132), the aggressive NSS group (6.7 %, 95 %CI 2.5 % – 10.9 %; 9 /134) and the standard LRS group (11.6 %, 95 %CI 6.1 % – 17.2 %; 15 /129; P = 0.03). In the two-group comparisons, the ITT PEP rate was significantly lower for the aggressive LRS group than for the standard LRS group (relative risk [RR] 0.26, 95 %CI 0.08 – 0.76; P = 0.008). There was no significant difference in the ITT PEP rate between the aggressive NSS group and the standard LRS group (RR 0.57, 95 %CI 0.26 – 1.27; P = 0.17). Conclusion  Aggressive hydration with LRS is the best approach to intravenous hydration for the prevention of PEP in average-to-high risk patients.
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Hyun, Jong Jin
Ansan Hospital (Department of Gastroenterology and Hepatology, Ansan Hospital)
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