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Aggressive hydration compared to standard hydration with lactated ringer’s solution for prevention of post endoscopic retrograde cholangiopancreatography pancreatitis

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Abstract

Background and aims

Previous studies have suggested that aggressive hydration with lactated ringer solution are one of the protective factors in preventing post endoscopic retrograde cholangiopancreatography (post-ERCP). We conducted a systematic review and meta-analysis to examine the efficacy aggressive hydration with lactated Ringer solution in preventing PEP.

Methods

All published and unpublished articles on aggressive hydration with lactated ringer solution in those underwent ERCP procedure for any reasons were screened for eligibility. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. This paper doesn’t need the IRB approval.

Results

Seven RCTs met the inclusion criteria. Meta-analysis indicates that aggressive hydration with lactated Ringer solution were associated with lower PEP rate.[odds ratio (OR) 0.29; 95% confidence interval (CI) 0.18–0.48]; lower incidence of hyperamylasemia (OR 0.49; 95% CI 0.35, 0.69) and lower risk of pain (OR 0.28; 95% CI 0.10–0.81). The association between aggressive hydration with lactated Ringer solution and incidence of moderate severity PEP were unclear (OR 0.57; 95% CI 0.22, 1.45). Sensitivity analyses also showed that omitting 1 study from analysis of PEP rate could reduce the heterogeneity but did not change the conclusion of this meta-analysis. A cumulating meta-analysis was performed statistically which showed a stable result of overall incidence of PEP.

Conclusions

Aggressive hydration with lactated Ringer solution was a protective factor in reducing the overall incidence of PEP, hyperamylasemia and risk of abdominal pain.

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Funding

This work was funded by the National Natural Science Foundation of China (Grant No. 81572424), Natural Science Foundation of Guangdong Province (Grant No. 2017A030313482), Guangzhou Municipal Science and Technology Project (Grant No. 201607010164), Scientific Research Project of Guangzhou Municipal Colleges and Universities (Grant No. 1201610322).

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Author notes

  1. Rong-Chang Wang and Ze-Kun Jiang have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, People’s Republic of China

    Rong-Chang Wang, Ze-Kun Jiang, Ying-Kang Xie & Jing-Song Chen

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  1. Rong-Chang Wang
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  2. Ze-Kun Jiang
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Contributions

All authors took part in making searching strategy, study selection criteria, discussion and final approval of the article. ZK Jiang and YK Xie contributed into data extraction, statistical analyses and making table/figures. RC Wang contributed to double checking of included studies, quality assessment and bias assessment. JS-Chen finished the final checking of all content in this paper.

Corresponding author

Correspondence to Jing-Song Chen.

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Disclosures

Rong-Chan Wang, Ze-Kun Jiang, Ying-Kang Xie and Jing-Song Chen have no conflicts of interest or financial ties to disclose.

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Wang, RC., Jiang, ZK., Xie, YK. et al. Aggressive hydration compared to standard hydration with lactated ringer’s solution for prevention of post endoscopic retrograde cholangiopancreatography pancreatitis. Surg Endosc 35, 1126–1137 (2021). https://doi.org/10.1007/s00464-020-07477-9

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  • DOI: https://doi.org/10.1007/s00464-020-07477-9

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