P2746 - Aggressive versus Standard Peri-Procedural Hydration to Prevent Post Endoscopic Retrograde (ERCP) Pancreatitis: A Meta Analysis of Randomized Control Trials

Rishi Das, MD, MPH¹, Aneesa Chowdhury, MD¹, Andrew Foong, MD¹, Thu A. Mai, MD¹, Jonathan Sadik, MD¹, Selena Zhou, MD¹, Robyn Rosasco, MS², Bashar Qumseya, MD, MPH³, James Buxbaum, MD^1
1University of Southern California, Los Angeles, CA; ²Florida State University, Tallahassee, FL; ³University of Florida, Gainesville, FL

Introduction: Therapeutic ERCP is integral to the treatment of a number of common disorders, but is associated with a 5-15% rate of post ERCP pancreatitis (PEP). Aggressive intravenous hydration has shown promise to reduce this adverse event but trials have produced mixed results. We aim to clarify its performance through systematic review and meta-analysis.

Methods: In conjunction with a health science librarian, Pubmed, EMBASE, Cochrane Library, OVID Medline , Web of Science, ClinicalTrials.gov were queried from inception through April 2021 to identify randomized control studies comparing aggressive versus standard hydration for prevention of post ERCP pancreatitis (PEP). Pooled odds ratio (OR) and 95% confidence intervals (CI) were calculated using the random effects model.

Results: The search yielded 584 citations that were assessed by two reviewers, with 46 articles selected for full text review. Eleven RCTs, with N = 3267 participants were included in our analysis, the most frequent indication (64%) was for choledocholithiasis.

Aggressive hydration was associated with reduced incidence of PEP (OR = 0.47, CI: 0.29 – 0.77, p = 0.0068 compared to standard hydration. Furthermore, the incidence of hyperamylasemia (OR = 0.51, CI: 0.34 - 0.77, p = 0.0084), abdominal pain (OR = 0.30, CI: 0.11 - 0.76, p = 0.024)and length of hospitalization (SMD: -0.20, CI: -0.55 - 0.16, p = 0.1761) were decreased with aggressive hydration. There was a trend toward reduced incidence of moderate-severe pancreatitis (OR: 0.33, CI: 0.072 – 1.53, p = 0.27). Only one study compared hydration strategy in patients universally receiving rectal NSAIDs, limiting subgroup analysis.

Discussion: Aggressive hydration is associated with a significant reduction of post ERCP pancreatitis. Studies in the setting of universal NSAID use are required to fully elucidate its role.


Figure: Figure 1: Forest Plot Illustrating Odds of Pancreatitis (OR) Comparing Aggressive Hydration (AH) vs Standard Hydration (SH)

	Aggressive vs Standard Hydration
	Pooled Ratio	95% CI	I2	p-value
PEP (Total)	OR= 0.47	[0.29, 0.77]	38%	0.0068
Mod-Severe PEP	OR = 0.33	[0.072 , 1.53]	0%	0.22
Hyperamylasemia	OR = 0.51	[0.34,0.77]	47%	0.0084
Abdominal Pain	OR= 0.30	[0.11 – 0.76]	73%	0.024
Hospitalization Days	SMD = 0.66	[0.41 – 1.08]	65%	0.180

*SMD: Standard Mean Difference (g)


Table: Table 1: Pooled Effect Measures Comparing Aggressive vs Standard Hydration


Disclosures:
Rishi Das indicated no relevant financial relationships.
Aneesa Chowdhury indicated no relevant financial relationships.
Andrew Foong indicated no relevant financial relationships.
Thu Mai indicated no relevant financial relationships.
Jonathan Sadik indicated no relevant financial relationships.
Selena Zhou indicated no relevant financial relationships.
Robyn Rosasco indicated no relevant financial relationships.
Bashar Qumseya indicated no relevant financial relationships.
James Buxbaum indicated no relevant financial relationships.


Rishi Das, MD, MPH¹, Aneesa Chowdhury, MD¹, Andrew Foong, MD¹, Thu A. Mai, MD¹, Jonathan Sadik, MD¹, Selena Zhou, MD¹, Robyn Rosasco, MS², Bashar Qumseya, MD, MPH³, James Buxbaum, MD¹. P2746 - Aggressive versus Standard Peri-Procedural Hydration to Prevent Post Endoscopic Retrograde (ERCP) Pancreatitis: A Meta Analysis of Randomized Control Trials, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.