Combined lactated Ringer's solution, rectal indomethacin reduces post-ERCP pancreatitis
Lactated Ringer’s solution infusion combined with rectal indomethacin reduced the incidence and readmission rates for post-endoscopic retrograde cholangiopancreatography pancreatitis compared with either management strategy alone.
“Acute pancreatitis is a potential ERCP adverse event that results in substantial medical costs and patient morbidity. Post-ERCP pancreatitis [PEP] incidence varies widely in the literature,” Khellaf Amalou, MD, of the Hospital Center De L’Armee in Algiers, Algeria, said in her presentation during UEG Week virtual. “Based on the Mediterranean and European American recommendation, rectal indomethacin (IND) is widely used as preventive strategy for post-ERCP pancreatitis. The use of an infusion of lactated Ringer’s (LR) solution has shown benefit in the prevention of acute pancreatitis.”
In a randomized, double-blind, controlled trial, Amalou and colleagues aimed to evaluate the efficacy of IND with or without bolus LR among 210 patients at a high risk for PEP. Patients underwent fluid infusion with either LR (1 L), IND or combined LR (1 L) and IND (n = 70 patients per group); studied outcomes included the incidence of PEP, severe acute pancreatitis, localized adverse events and death as well as hospital length of stay and rate of readmission.
According to analysis, PEP occurred in 17% of patients in the LR group, 8% of patients in the IND group and 7% of patients in the combined LR and IND group. Amalou noted lower readmission rates among the combined LR and IND group compared with the LR group (2% vs. 10%). Severe pancreatitis occurred among two patients in the LR group and one patient in the IND group as well as the combined LR and IND group.
“We believe that using more practical combination preventative strategies in patients at high-risk for PEP was more beneficial than a single-modality approach,” Amalou concluded. “Lactated Ringer’s solution plus rectal indomethacin can reduce the incidence of post-ERCP pancreatitis and post-procedure readmission compared with lactated Ringer’s and indomethacin alone in high-risk patients.”