Smeets X J N M, da Costa D W, Besselink M G, Bruno M J, Fockens P, Mulder C J J, van der Hulst R W, Vleggaar F P, Timmer R, Drenth J P H, van Geenen E J M
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands.
Department of Radiology, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands.
Aliment Pharmacol Ther. 2016 Sep;44(6):541-53. doi: 10.1111/apt.13744. Epub 2016 Jul 22.
With an overall incidence of 3.5%, pancreatitis is the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP). Periprocedural hydration may prevent post-ERCP pancreatitis by maintaining pancreatic microperfusion, thereby inhibiting the pancreatic inflammatory response. However, the evidence for periprocedural hydration as a preventive measure is unclear.
To conduct a systematic review to assess the evidence regarding periprocedural hydration as a preventive measure for post-ERCP pancreatitis.
We searched PubMed and EMBASE databases and adhered to the PRISMA guidelines. We included studies addressing periprocedural hydration as a preventive measure to reduce frequency and severity of post-ERCP pancreatitis. Study quality was assessed by using the MINORS and Cochrane Collaboration's tool.
Six studies with a total of 1102 patients were included. Two randomised controlled trials reported a decreased incidence of post-ERCP pancreatitis after hydration: 0% vs. 17% (P = 0.016) and 5.3% vs. 22.7% (P = 0.002). A third trial and two case-controls studies did not report significant differences. Two retrospective studies found that patients with mild post-ERCP pancreatitis had received significantly more fluids during (mean 940 mL vs. 810 mL; P = 0.031) or after ERCP (median 2834 mL vs. 2044 mL; P < 0.02) compared to patients with moderate/severe disease. Adverse events of periprocedural hydration were not reported in any of the included studies. The different methodologies of the included studies precluded a formal data synthesis.
There is some evidence to suggest that hydration affords protection against post-ERCP pancreatitis, but study heterogeneity precludes firm conclusions. Adequately powered randomised trials are needed to evaluate the preventive effect of periprocedural hydration.
胰腺炎是内镜逆行胰胆管造影术（ERCP）最常见的并发症，总体发生率为3.5%。围手术期补液可通过维持胰腺微灌注来预防ERCP术后胰腺炎，从而抑制胰腺炎症反应。然而，围手术期补液作为一种预防措施的证据尚不清楚。
进行一项系统评价，以评估围手术期补液作为预防ERCP术后胰腺炎措施的证据。
我们检索了PubMed和EMBASE数据库，并遵循PRISMA指南。我们纳入了将围手术期补液作为预防措施以降低ERCP术后胰腺炎发生率和严重程度的研究。使用MINORS和Cochrane协作组的工具评估研究质量。
纳入了6项研究，共1102例患者。两项随机对照试验报告补液后ERCP术后胰腺炎的发生率降低：0%对17%（P = 0.016）和5.3%对22.7%（P = 0.002）。第三项试验和两项病例对照研究未报告显著差异。两项回顾性研究发现，与中度/重度疾病患者相比，轻度ERCP术后胰腺炎患者在ERCP期间（平均940 mL对810 mL；P = 0.031）或术后（中位数2834 mL对2044 mL；P < 0.02）接受的液体显著更多。纳入的研究均未报告围手术期补液的不良事件。纳入研究的不同方法排除了进行正式数据合成的可能性。
有一些证据表明补液可预防ERCP术后胰腺炎，但研究的异质性妨碍得出确切结论。需要开展足够样本量的随机试验来评估围手术期补液的预防效果。
