{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:38:20Z","timestamp":1782301100145,"version":"3.54.5"},"reference-count":27,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T00:00:00Z","timestamp":1718236800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>We aimed to evaluate comparative outcomes of aggressive <jats:italic>versus<\/jats:italic> non\u2010aggressive intravenous fluid (IVF) therapy in patients with acute pancreatitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic search of electronic data sources and bibliographic reference lists were conducted. All randomized controlled trials (RCTs) reporting outcomes of aggressive <jats:italic>versus<\/jats:italic> non\u2010aggressive IVF therapy in acute pancreatitis were included and their risk of bias were assessed. Effect sizes were determined for overall mortality, systemic inflammatory response syndrome (SIRS), sepsis, respiratory failure, pancreatic necrosis, severe pancreatitis, clinical improvement, AKI, and length of stay using random\u2010effects modeling. Trial sequential analysis was conducted to determine risk of types 1 or 2 errors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 10 RCTs reporting 993 patients with acute pancreatitis who received aggressive (<jats:italic>n<\/jats:italic>\u00a0=\u00a0475) or non\u2010aggressive (<jats:italic>n<\/jats:italic>\u00a0=\u00a0518) IVF therapy. Aggressive IVF therapy was associated with significantly higher rate of sepsis (OR: 2.68, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.0005) and longer length of stay (MD: 0.94, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.00001) compared with the non\u2010aggressive approach. There was no statistically significant difference in mortality (RD: 0.02, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.31), SIRS (OR: 0.93, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.89), respiratory failure (OR: 2.81, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.07), pancreatic necrosis (OR: 1.98, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.06), severe pancreatitis (OR: 1.31, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.38), clinical improvement (OR: 1.12, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.83) or AKI (OR: 1.06, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.91) between the two groups. Sub\u2010group analysis demonstrated higher morbidity and mortality associated with the aggressive approach in more severe disease. Trial sequential analysis detected risk of type 2 error.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Aggressive IVF therapy may be associated with higher morbidity in patients with acute pancreatitis compared with the non\u2010aggressive approach, particularly in patients with more severe disease. It may also prolong length of hospital stay. The available evidence is subject to type 2 error indicating the need for adequately powered RCTs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.16648","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T06:48:24Z","timestamp":1718347704000},"page":"2018-2030","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Meta\u2010analysis and trial sequential analysis of randomized controlled trials comparing aggressive <i>versus<\/i> non\u2010aggressive intravenous fluid therapy in acute pancreatitis: an insight into the existence of type 2 error"],"prefix":"10.1111","volume":"39","author":[{"given":"Daisy","family":"Evans","sequence":"first","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital University Hospitals of North Midlands NHS Trust  Stoke\u2010on\u2010Trent UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6159-1068","authenticated-orcid":false,"given":"Shahin","family":"Hajibandeh","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital University Hospitals of North Midlands NHS Trust  Stoke\u2010on\u2010Trent UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3294-4335","authenticated-orcid":false,"given":"Shahab","family":"Hajibandeh","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery Morriston Hospital  Swansea UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tejinderjit S","family":"Athwal","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital University Hospitals of North Midlands NHS Trust  Stoke\u2010on\u2010Trent UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Satyadas","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery Manchester Royal Infirmary Hospital  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,13]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575\u2010019\u20100158\u20102"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.01.068"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916\u2010020\u201001859\u20105"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro\u20102018\u2010101102"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017\u2010019\u20100247\u20100"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1159\/000506830"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2021.06.004"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2008.05.005"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.01.032"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.20317"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2017.40"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.0366-6999.2009.02.011"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620\u2010018\u20105328\u20105"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pan.2014.09.008"},{"key":"e_1_2_6_16_1","first-page":"257","article-title":"Management of acute pancreatitis in the early stage","volume":"10","author":"Zarnescu NO","year":"2015","journal-title":"Maedica (Bucur)."},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700"},{"key":"e_1_2_6_18_1","volume-title":"Chapter 8: Assessing Risk of Bias in a Randomized Trial [Internet]","author":"Higgins JPT","year":"2020"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.0366-6999.2010.13.005"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2011.04.026"},{"key":"e_1_2_6_21_1","first-page":"794","article-title":"The value of early aggressive hydration in patients with mild acute pancreatitis","volume":"28","author":"Li H","year":"2020","journal-title":"Chin J Emerg Med."},{"key":"e_1_2_6_22_1","first-page":"844","article-title":"The application value of early aggressive hydration among patients with mild acute pancreatitis","volume":"41","author":"Wang SY","year":"2020","journal-title":"Guangdong Med J."},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000001528"},{"key":"e_1_2_6_24_1","volume-title":"Preliminary impact of the initial fluid resuscitation with different volume on the prognosis of acute pancreatitis not match the standard of severe AP. 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