Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA.
Division of Gastroenterology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA.
Pancreatology. 2019 Sep;19(6):819-827. doi: 10.1016/j.pan.2019.07.046. Epub 2019 Jul 30.
Periprocedural intravenous hydration is suggested to decrease the risk of post-ERCP pancreatitis (PEP). However, quality of evidence supporting this suggestion remains poor. Here we hypothesized that aggressive hydration(AH) could be an effective preventive measure.
Pubmed, EMBASE, CINAHL, Google Scholar, Clinical Trials. gov, Clinical Key, International Standard Randomized Trial Number registry as well as secondary sources were searched through January 2019 to identify randomized controlled studies comparing AH to standard hydration (SH) for prevention of PEP. Pooled odds ratio (OR) and 95% confidence intervals (CIs) were calculated using the random-effects model. RevMan 5.3 was used for analysis.
A total of 9 RCTs, with 2094 patients, were included in the meta-analysis. AH reduced incidence of PEP by 56% compared to SH (OR = 0.44, CI:0.28-0.69; p = 0.0004). The incidence of post-ERCP hyperamylasemia also decreased with AH compared to SH (OR = 0.51; p = 0.001). Length of stay decreased by 1 day with AH (Mean Difference (MD): -0.89 d; p = 0.00002). There was no significant difference in adverse events related to fluid overload between two groups (OR:1.29; p = 0.81) and post-ERCP abdominal pain (OR:0.35; p = 0.17). Numbers of patient to be treated with AH to prevent one episode of PEP was 17. Final results of the meta-analysis were not affected by alternative effect measures or statistical models of heterogeneity.
Aggressive hydration is associated with a significantly lower incidence of PEP and it appears to be an effective and safe strategy for the prevention of Post ERCP pancreatitis.
经内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）的风险可通过围手术期静脉补液来降低。然而，支持这一建议的证据质量仍然较差。在此，我们假设积极补液（AH）可能是一种有效的预防措施。
通过 2019 年 1 月之前的 PubMed、EMBASE、CINAHL、Google Scholar、ClinicalTrials.gov、ClinicalKey、国际标准随机对照试验编号注册处以及次要来源检索了比较 AH 与标准补液（SH）预防 PEP 的随机对照研究。使用随机效应模型计算合并优势比（OR）和 95%置信区间（CI）。使用 RevMan 5.3 进行分析。
共有 9 项 RCT 纳入了荟萃分析，共计 2094 名患者。与 SH 相比，AH 降低了 56%的 PEP 发生率（OR=0.44，CI：0.28-0.69；p=0.0004）。与 SH 相比，AH 还降低了 ERCP 后高淀粉酶血症的发生率（OR=0.51；p=0.001）。与 SH 相比，AH 组的住院时间减少了 1 天（MD：-0.89 天；p=0.00002）。两组之间与液体超负荷相关的不良事件（OR：1.29；p=0.81）和 ERCP 后腹痛（OR：0.35；p=0.17）无显著差异。预防 1 例 PEP 需治疗的患者人数为 17。荟萃分析的最终结果不受替代效应测量或异质性统计模型的影响。
积极补液与 PEP 的发生率显著降低相关，并且似乎是预防 ERCP 后胰腺炎的一种有效且安全的策略。
