Faculty Collaboration Database

Do larger periprocedural fluid volumes reduce the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis? Pancreas 2014 May;43(4):642-7

Date

04/10/2014

Pubmed ID

24713841

Pubmed Central ID

PMC4024358

DOI

10.1097/MPA.0000000000000101

Scopus ID

2-s2.0-84898484248 (requires institutional sign-in at Scopus site)   27 Citations

Abstract

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.

Author List

DiMagno MJ, Wamsteker EJ, Maratt J, Rivera MA, Spaete JP, Ballard DD, Elmunzer J, Saini SD

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adult
Chi-Square Distribution
Cholangiopancreatography, Endoscopic Retrograde
Female
Fluid Therapy
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Pancreatitis
Retrospective Studies
Risk Factors
Severity of Illness Index
Treatment Outcome