Aggressive IV Fluids Plus Rectal NSAIDs Don ’ t Prevent Post-ERCP Pancreatitis

Dr. Moulder Clinical question: Does the addition of aggressive intravenous hydration to rectal nonsteroidal anti-inflammatory drugs (NSAIDs) help prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis? Background: Pancreatitis is a common complication of ERCP. The use of prophylactic rectal NSAIDs reduces the development of post-ERCP pancreatitis. Evidence has emerged that aggressive periprocedural hydration using lactated Ringer’s solution reduces the risk of post-ERCP pancreatitis, though this was not studied in combination with rectal NSAIDs. This trial aimed to evaluate the value of aggressive hydration in combination with prophylactic NSAIDS to prevent post-ERCP pancreatitis. Study design: The Fluid Hydration to Prevent Post-ERCP Pancreatitis In Average- To High-Risk Patients Receiving Prophylactic Rectal NSAIDS Trial (FLUYT) was a multicenter, open-label, randomized, controlled trial. Setting: The trial was conducted by the Dutch Pancreatitis Study group comprising four university medical centers and 18 teaching hospitals in the Netherlands between June 2015 and June 2019. Synopsis: In this trial, 826 patients undergoing ERCP, aged 18 to 85, with moderate to high risk of post-ERCP pancreatitis, were randomized to receive aggressive periprocedural hydration (20 mL/kg intravenous lactated Ringer’s within 60 minutes of the start of ERCP, followed by 3 mL/kg/hour for 8 hours) in addition to rectal NSAIDs (100 mg of diclofenac or indomethacin). ...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: In the Literature Pancreas and Biliary Tract Source Type: research