{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T12:45:59Z","timestamp":1791549959506,"version":"4.3.4"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"07","license":[{"start":{"date-parts":[[2022,4,25]],"date-time":"2022-04-25T00:00:00Z","timestamp":1650844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background and study aims\u2002Post-ERCP pancreatitis (PEP) is a common adverse event in high-risk patients. Current intervention known to reduce the incidence and severity of PEP include pancreatic duct stent placement, nonsteroidal anti-inflammatory drugs per rectum, and intravenous (IV) fluids. We compared aggressive normal saline (NS) vs aggressive lactated Ringer\u2019s (LR) infusion for the prevention of PEP in high-risk patients undergoing ERCP.<\/jats:p><jats:p>\n          Patients and methods\u2002Patients were randomized to receive either an aggressive infusion of NS or LR. The infusion was started at a rate of 3\u200amL\/kg\/hr and continued throughout the ERCP procedure. A 20\u200amL\/kg bolus was given at the end of the procedure, then continued at a rate of 3\u200amL\/kg\/hr.<\/jats:p><jats:p>\n          Results\u2002A total of 136 patients were included in our analysis. The incidence of PEP was 4\u200a% (3\/72 patients) in the LR group versus 11\u200a% (7\/64 patients) in the NS group resulting in a relative risk (RR) of 0.38 (95\u200a% confidence interval [CI] 0.10 to 1.42; P\u200a=\u200a0.19). The relative risk reduction (RRR) was 0.62 (95\u200a% CI \u20130.41 to 0.90) along with an absolute risk reduction (ARR) of 0.07 (95\u200a% CI \u20130.025 to 0.17) and an number needed to treat of 15 (95\u200a% CI \u201341 to 6).<\/jats:p><jats:p>\n          Conclusions\u2002To our knowledge, this is the first study comparing aggressive IV NS to aggressive IV LR in high-risk patients. The incidence of PEP was lower in the group receiving an aggressive LR infusion (4\u200a%) compared to NS infusion (11\u200a%). However, the difference was not statistically significant likely due to poor accrual thereby impacting the power of the study.<\/jats:p>","DOI":"10.1055\/a-1834-6568","type":"journal-article","created":{"date-parts":[[2022,4,25]],"date-time":"2022-04-25T23:52:25Z","timestamp":1650930745000},"page":"E933-E939","source":"Crossref","is-referenced-by-count":11,"title":["Efficacy of aggressive hydration with normal saline versus lactated Ringer\u2019s solution for the prevention of post-ERCP pancreatitis in high-risk patients: a randomized controlled trial"],"prefix":"10.1055","volume":"10","clinical-trial-number":[{"clinical-trial-number":"nct03215862","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct0321586","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Rupal","family":"Patel","sequence":"additional","affiliation":[{"name":"University of South Florida College of Medicine, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Tampa, Florida, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Bertran-Rodriguez","sequence":"additional","affiliation":[{"name":"University of South Florida College of Medicine, Department of Internal Medicine, Tampa, Florida, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambuj","family":"Kumar","sequence":"additional","affiliation":[{"name":"University of South Florida College of Medicine, Office of Research, Department of Internal Medicine, Tampa, Florida, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Brady","sequence":"additional","affiliation":[{"name":"University of South Florida College of Medicine, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Tampa, Florida, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Gomez-Esquivel","sequence":"additional","affiliation":[{"name":"University of South Florida College of Medicine, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Tampa, Florida, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinesh","family":"Changela","sequence":"additional","affiliation":[{"name":"University of South Florida College of Medicine, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Tampa, Florida, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Negar","family":"Niknam","sequence":"additional","affiliation":[{"name":"University of South Florida College of Medicine, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Tampa, Florida, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pushpak","family":"Taunk","sequence":"additional","affiliation":[{"name":"University of South Florida College of Medicine, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Tampa, Florida, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,7,15]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.gie.2014.06.045","article-title":"Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials","volume":"81","author":"B Kochar","year":"2015","journal-title":"Gastrointest Endosc"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1055\/a-1075-4080","article-title":"ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) guideline","volume":"52","author":"J M Dumonceau","year":"2020","journal-title":"Endoscopy"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.gie.2018.10.013","article-title":"Guidewire in the pancreatic duct: key to risk and rescue for post-ERCP pancreatitis","volume":"89","author":"A Haseeb","year":"2019","journal-title":"Gastrointest Endosc"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1111\/jgh.14957","article-title":"The number of wire placement in the pancreatic duct and metal biliary stent as risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis","volume":"35","author":"S H Shin","year":"2020","journal-title":"J Gastroenterol Hepatol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1053\/j.gastro.2020.03.019","article-title":"How to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis","volume":"158","author":"I Boskoski","year":"2020","journal-title":"Gastroenterology"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.gie.2014.09.020","article-title":"Pancreatic stent placement remains a cornerstone of prevention of post-ERCP pancreatitis, but it requires specialized techniques","volume":"81","author":"M A Arain","year":"2015","journal-title":"Gastrointest Endosc"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1056\/NEJMoa1111103","article-title":"A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis","volume":"366","author":"B J Elmunzer","year":"2012","journal-title":"N Engl J Med"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"e68","DOI":"10.1097\/MCG.0000000000000856","article-title":"The efficiency of aggressive hydration with lactated ringer solution for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis","volume":"51","author":"D Wu","year":"2017","journal-title":"J Clin Gastroenterol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.gie.2016.06.051","article-title":"Adverse events associated with ERCP","volume":"85","author":"V Chandrasekhara","year":"2017","journal-title":"Gastrointest Endosc"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1038\/ajg.2013.218","article-title":"American College of Gastroenterology guideline: management of acute pancreatitis","volume":"108","author":"S Tenner","year":"2013","journal-title":"Am J Gastroenterol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.pan.2019.07.046","article-title":"Peri-procedural aggressive hydration for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis prophylaxsis: meta-analysis of randomized controlled trials","volume":"19","author":"D Radadiya","year":"2019","journal-title":"Pancreatology"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1007\/s00464-020-07477-9","article-title":"Aggressive hydration compared to standard hydration with lactated ringer\u02bcs solution for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis","volume":"35","author":"R C Wang","year":"2021","journal-title":"Surg Endosc"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"E834","DOI":"10.1055\/a-1149-1359","article-title":"Fluid type and volume reduce risk of post-ERCP pancreatitis and length of hospital stay in high-risk patients: a secondary analysis of the INDIEH trial","volume":"8","author":"R Talukdar","year":"2020","journal-title":"Endosc Int Open"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.gie.2016.10.033","article-title":"Lactated Ringer\u02bcs solution in combination with rectal indomethacin for prevention of post-ERCP pancreatitis and readmission: a prospective randomized, double-blinded, placebo-controlled trial","volume":"85","author":"S RS Mok","year":"2017","journal-title":"Gastrointest Endosc"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1055\/s-0043-122386","article-title":"Aggressive intravenous hydration with lactated Ringer\u02bcs solution for prevention of post-ERCP pancreatitis: a prospective randomized multicenter clinical trial","volume":"50","author":"C H Park","year":"2018","journal-title":"Endoscopy"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"AB591","DOI":"10.1016\/j.gie.2018.04.2274","article-title":"Tu1422 High volume peri-procedural lactated ringer\u2019s and normal saline are equally effective in preventing post-ERCP pancreatitis","volume":"87","author":"R Patel","year":"2018","journal-title":"Gastrointest Endosc"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.cgh.2013.07.026","article-title":"Aggressive hydration with lactated Ringer\u02bcs solution reduces pancreatitis after endoscopic retrograde cholangiopancreatography","volume":"12","author":"J Buxbaum","year":"2014","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"838","DOI":"10.4103\/1735-1995.170597","article-title":"Aggressive hydration with Lactated Ringer\u02bcs solution as the prophylactic intervention for postendoscopic retrograde cholangiopancreatography pancreatitis: A randomized controlled double-blind clinical trial","volume":"20","author":"A Shaygan-Nejad","year":"2015","journal-title":"J Res Med Sci"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/S2468-1253(21)00057-1","article-title":"Aggressive fluid hydration plus non-steroidal anti-inflammatory drugs versus non-steroidal anti-inflammatory drugs alone for post-endoscopic retrograde cholangiopancreatography pancreatitis (FLUYT): a multicentre, open-label, randomised, controlled trial","volume":"6","author":"CJ Sperna Weiland","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"}],"container-title":["Endoscopy International Open"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1834-6568.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T10:23:11Z","timestamp":1660126991000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1834-6568"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,25]]},"references-count":19,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2022,7,15]]},"published-print":{"date-parts":[[2022,7]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1834-6568","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2364-3722","2196-9736"],"issn-type":[{"value":"2364-3722","type":"print"},{"value":"2196-9736","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,4,25]]},"published":{"date-parts":[[2022,4,25]]}}}