S0102 Evaluation of the Effect of Aggressive Hydration on the Incidence of Post-ERCP Pancreatitis

Abstract

INTRODUCTION: Post ERCP pancreatitis (PEP) is a significant complication with increased morbidity, occasional mortality and increased healthcare costs with an incidence of 9.7% and up to 14.7% in high risk patients. Aggressive hydration during peri-procedure period and for an additional 8 hours post procedure has been shown to reduce the risk of PEP. Our aim was to assess the effect of aggressive hydration for 24 hours post ERCP on the incidence of PEP. METHODS: At our institution, we instituted aggressive hydration therapy (20 ml/Kg bolus of isotonic IVF during procedure followed by 3–5 ml/Kg for 24 hrs) for every hospitalized patient between the ages of 18 to 70 years undergoing ERCP. After 24 hours, IVF were discontinued if patients were able to tolerate oral intake. Patients were monitored for signs of volume overload (lower extremity swelling, pulmonary edema, shortness of breath and rise in BP). We retrospectively reviewed all inpatient ERCPs performed between 10/2017 and 10/2018. Patients with advanced CKD, CHF, COPD with supplemental oxygen, pregnant, or septic were excluded. Patients were high risk for PEP: females <50 years of age, normal serum bilirubin, prior history of pancreatitis, sphincter of Oddi dysfunction, pre-cut sphincterotomy, PD sphincteroplasty, PD cannulation, and PD injection. All high-risk patients received 100 mg rectal indomethacin, unless contraindicated. Stent was placed in PD if cannulated. Average risk patients received rectal indomethacin at the discretion of the endoscopist. PEP was defined based on the Cotton’s criteria. Severity of pancreatitis was defined based on the revised Atlanta criteria. RESULTS: There were a total of 278 inpatient ERCPs between 10/2017 and 10/2018. A total of 164 patients met the inclusion criteria. Fifty-nine patients were considered average risk and 105 were high risk (Table 1). The overall PEP rate in the study cohort was 7.3%. In high risk group overall PEP rate was 9.5% and 3.4% in average risk group. The rate of moderate-severe PEP in the study cohort was 1.8% and in high risk patients was 1.9% (Tables 2 and 3). Four patients developed mild rise in BP while 2 patients developed lower extremity swelling. There were no cases of volume overload necessitating stoppage of IVF in either groups. CONCLUSION: In conclusion, extending aggressive hydration to 24 hours post ERCP helps reduce the incidence of PEP, especially moderate to severe PEP. Further randomized controlled studies are needed to collaborate our study findings.Table 1.: Characteristics of PatientsTable 2.: Characteristics of average risk patients with PEPTable 3.: Characteristics of high risk patients with PEP