MetroHealth Medical Center Cleveland, OH, United States
Nabil El Hage Chehade, MD1, Sara Ghoneim, MD2, Anastasia Chahine, MD3, Alexa Truong, BS4, Abdulfatah Issak, MD5, Jason Samarasena, MD6 1MetroHealth Medical Center, Cleveland, OH; 2University of Nebraska Medical Center, Omaha, NE; 3H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine, Orange, CA; 4University of California Irvine Medical Center, Orange, CA; 5Case Western Reserve University, Cleveland, OH; 6University of California - Irvine, Orange, CA
Introduction: Pancreatitis is the most prevalent serious complication of endoscopic retrograde cholangiopancreatography (ERCP). Different approaches have been suggested to prevent or reduce this complication. Recent studies have compared the utility of aggressive intravenous fluid hydration (IVF) with standard hydration or placebo. Limited studies investigated the use of aggressive IVF versus non-steroidal inflammatory drugs (NSAIDs) in preventing post-ERCP pancreatitis (PEP). We performed a systematic review and meta-analysis to evaluate the benefit of aggressive IVF in preventing PEP.
Methods: A literature search was performed using Scopus, PubMed/MEDLINE, and Cochrane databases in February 2021. Studies included in our meta-analysis involved adults patients undergoing ERCP who received aggressive IVF. Analysis was conducted using the Mantel-Haenszel model using the odds ratio (OR) to assess the rate of PEP. The results were pooled together using Reviewer Manager 5.4 software, and heterogeneity was quantified using I2 statistics.
Results: Sixteen randomized-controlled clinical trials involving 4344 patients were included in the final analysis. Included studies were rated as moderate quality using the Jadad Scale. Aggressive IVF demonstrated significant benefit over standard hydration or placebo in preventing PEP (OR 0.44, 95% CI [0.31, 0.63], P< 0.00001, I2= 30%). However, the rate of PEP was similar in the aggressive IVF and NSAIDs groups (OR 0.76, 95% CI [0.32, 1.84], P= 0.55). Combining aggressive IVF with NSAIDs did not demonstrate any benefit in preventing PEP compared to NSAIDs alone (OR 0.57, 95% CI [0.23, 1.40], P= 0.22).
Discussion: The use of aggressive IVF provides a benefit over standard hydration in preventing PEP. Aggressive IVF use alone or in combination with NSAIDs failed to demonstrate any benefit over NSAIDs alone in preventing PEP.
Figure: Forest plots comparing the rate of post-ERCP pancreatitis (PEP) in patients receiving (A) aggressive fluid hydration versus standard hydration or placebo, (B) aggressive fluid hydration versus NSAIDs, (C) aggressive fluid hydration and NSAIDs versus NSAIDs alone. CI, confidence interval; IVF, intravenous fluids; M-H, Mantel-Haenszel; NSAIDs, non-steroidal anti-inflammatory drugs.
Nabil El Hage Chehade indicated no relevant financial relationships.
Sara Ghoneim indicated no relevant financial relationships.
Anastasia Chahine indicated no relevant financial relationships.
Alexa Truong indicated no relevant financial relationships.
Abdulfatah Issak indicated no relevant financial relationships.
Jason Samarasena indicated no relevant financial relationships.
Nabil El Hage Chehade, MD1, Sara Ghoneim, MD2, Anastasia Chahine, MD3, Alexa Truong, BS4, Abdulfatah Issak, MD5, Jason Samarasena, MD6. P0035 - The Benefit of Aggressive Intravenous Fluid Hydration in Preventing Post-ERCP Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.