Lactated Ringer's solution in combination with rectal indomethacin for prevention of post-ERCP pancreatitis and readmission: a prospective randomized, double-blinded, placebo-controlled trial

Abstract

In patients at high risk for PEP, LR + IND reduced the incidence of PEP and readmission rates compared with NS + placebo. (Clinical trial registration number: NCT02641561.).

Chinese expert consensus on perioperative medications for endoscopic retrograde cholangiopancreatography (ERCP)

“…However, the patients in both studies underwent diagnostic ERCP without using only guidewire, and the intubation time was long. Further, the definition of PEP in these studies were not standardized …”

“…with high-risk of PEP and reported that the combination to reduce PEP incidence significantly. 74 Another meta-analysis including 722 patients from 3 RCTs concluded that aggressive hydration with LRS could significantly reduce the incidence of PEP. 75 The optimal timing and safety of aggressive hydration with LRS needs to be evaluated in larger studies for conclusive results, especially in Chinese populations.…”

Postendoscopic retrograde cholangiopancreatography pancreatitis

“…According to Mok et al, they compared the difference between hydration with lactated Ringer's solution + rectal indomethacin and hydration with normal saline + rectal indomethacin for preventing PEP in high‐risk population. Indeed hydration with lactated Ringer's solution + rectal indomethacin reduced the incidence of PEP and readmission rate …”

“…Inhibitor of protease activation Gabexate mesylate Nafamostat Yuhara et al 38 Choi et al 39 Park et al 40 Yoo et al 41 Kim et al 42 6 5 45 Bang et al 46 9 2 mg sublingual 5 min prior to ERCP 2 mg sublingual 5 min prior to ERCP Sublingual route is more effective, timing is variable Indeed hydration with lactated Ringer's solution + rectal indomethacin reduced the incidence of PEP and readmission rate. 55…”

Recent advances in understanding and managing acute pancreatitis

“…Very recent meta-analyses and RCTs support using LR prior to ERCP to prevent PEP 96– 99 and to reduce moderate to severe PEP 96, 97 . Interestingly, a recent RCT shows that the combination of rectal indomethacin and LR compared with combination placebo and normal saline reduced the risk of PEP in high-risk patients 100 . An ongoing multicenter Dutch “FLUYT” RCT aims to determine the optimal combination of rectal NSAIDs and peri-procedural infusion of intravenous fluids to reduce the incidence of PEP and moderate to severe PEP 101 .…”