Abstract
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's (LR) and normal saline (NS) for PEP prevention.
A random-effects model was used. The primary outcome was risk of PEP. Effect estimates were expressed as risk difference (RD) and 95% confidence interval (CI).
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 to 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.
At equivalent fluid administration rates, using LR compared to 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.