Do larger periprocedural fluid volumes reduce the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis?
OBJECTIVE
Fluid therapy is a cornerstone of the early treatment of acute pancreatitis (AP), but data are conflicting on whether it affects disease severity. Administering greater fluid volumes (FVs) during induction of experimental AP preserves pancreatic perfusion and reduces severity but does not prevent onset of AP. We hypothesized that administering larger FV during endoscopic retrograde cholangiopancreatography (ERCP) associates with less severe post-ERCP pancreatitis (PEP).


METHODS
In a retrospective cohort study, we identified 6505 patients who underwent 8264 ERCPs between January 1997 and March 2009; 211 of these patients developed PEP (48 mild, 141 moderate, and 22 severe). Data for FVs were available for 173 patients with PEP.


RESULTS
In univariable analysis, only 1 of 16 variables was significantly associated with moderate to severe PEP--larger periprocedural FV was protective (0.94 T 0.3 L vs 0.81 T 0.4 L; P = 0.0129). Similarly,multivariable analysis of moderate to severe PEP identified 1 independent predictor-- larger periprocedural FV was protective (odds ratio, 0.20; 95% confidence interval, 0.05-0.83). Conversely, moderate to severe disease correlated with larger FV administered after PEP diagnosis(reflecting treatment decisions).


CONCLUSIONS
This hypothesis-generating study suggests that administering larger periprocedural FVs is protective against moderate to severe PEP. Prospective studies on this topic are warranted.
Matthew J
MJ
DiMagno
Erik-Jan
EJ
Wamsteker
Jennifer
J
Maratt
Mari A
MA
Rivera
Joshua P
JP
Spaete
Darren D
DD
Ballard
Joseph
J
Elmunzer
Sameer D
SD
Saini
D000208:Acute Disease; D000328:Adult; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome