Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis Prophylaxis: Does the Choice of Crystalloid Fluid Matter? A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Objectives: – The optimal crystalloid choice for post-ERCP pancreatitis (PEP) prophylaxis is not clear. To evaluate the published literature further, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing intravenous (IV) hydration with lactated Ringer (LR) and normal saline (NS) for PEP prevention. Materials and Methods: – A random-effects model was used. The primary outcome was the risk of PEP. Effect estimates were expressed as risk difference (RD) and 95% CI. Results: – Pooling analysis of published RCTs with 594 patients (41.1% males, mean age: 57.6) showed statistically significant risk reduction of PEP in the LR group compared with the NS group [RD: −0.04; 95% CI (−0.08, −0.00), P = 0.03, I2 = 0]. There was no significant risk difference in other adverse events. Conclusion: – At equivalent fluid administration rates, using LR compared with NS showed a significant risk reduction in PEP of 4% with a number needed to treat (NNT) of 25. LR may be the better crystalloid for ERCP. Further studies are needed to validate these results.