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Review
. 2021 May 7;13(5):e14897.
doi: 10.7759/cureus.14897.

Aggressive Hydration With Ringer's Lactate in the Prevention of Post-ERCP Pancreatitis: A Meta-Analysis

Samar Aljohani  1 , Hyder Mirghani  2
Affiliations
Review

Aggressive Hydration With Ringer's Lactate in the Prevention of Post-ERCP Pancreatitis: A Meta-Analysis

Samar Aljohani et al. Cureus. .

Abstract

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a dangerous complication and occurs in a considerable number of patients. However, since well-randomized controlled trials investigating aggressive hydration with Ringer's lactate are lacking, this meta-analysis assessed the role of aggressive hydration with Ringer's lactate alone or in combination with other therapies in the prevention of PEP. We searched PubMed, Cochrane Library, and Google Scholar for relevant articles. The search engine was set to randomize controlled trials and prospective cohorts assessing Ringer's lactate in PEP prevention either alone or in combination with non-steroidal anti-inflammatory drugs (NSAIDs) and stent. The keywords "aggressive hydration," "Ringer's lactate," "post-ERCP pancreatitis," "NSAIDs," "stent placement," and "somatostatin analogs" were used. The search was limited to a study on humans published in English with no limitation to the study period. Two hundred and six articles were retrieved. Only eight articles fulfilled the inclusion criteria. The studies showed a reduction of post-ERCP pancreatitis using aggressive hydration with Ringer's lactate alone (odds ratio 0.23, 95% CI 0.13 - 0.40, P-value < 0.001, I2 for heterogeneity = 0%, P-value = 0.61, Chi-square value 1.83, and degrees of freedom (df) 3. In addition, the combination of Ringer's lactate with stents or NSAIDs was superior to Ringer's lactate alone (odds ratio 0.63, 95% CI 0.41 - 0.98, P-value < 0.04, I2 for heterogeneity = 0%, P-value = 0.48, Chi-square value 2.47, and df 3). Aggressive hydration with Ringer's lactate alone was effective in the prevention of PEP with a superior effect when combined with stents and NSAIDs.

Keywords: aggressive hydration; endoscopic retrograde cholangiopancreatography (ercp); post-ercp pancreatitis (pep); ringer's lactate.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Aggressive hydration with ringer lactate for the prevention of post-ERCP pancreatitis
ERCP: endoscopic retrograde cholangiopancreatography
Figure 2
Figure 2. Ringer's lactate effects on post-ERCP pancreatitis
CI: confidence interval; ERCP: endoscopic retrograde cholangiopancreatography; M-H: Mantel-Haenszel
Figure 3
Figure 3. . Ringer's lactate in combination with other therapies effects on post-ERCP pancreatitis
CI: confidence interval; ERCP: endoscopic retrograde cholangiopancreatography; M-H: Mantel-Haenszel
See this image and copyright information in PMC

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