The Effectiveness of Additional Hydration for Hyperamylasemia After Endoscopic Retrograde Cholangiopancreatography: A Propensity-Matched Analysis.

Abstract

Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) is widely utilized to manage pancreatobiliary diseases, but post-ERCP pancreatitis (PEP) is an unsolved issue. Although post-procedural elevation of serum amylase level is useful for early prediction of PEP, effectiveness of early interventions for hyperamylasemia has not been evaluated. Therefore, we conducted this study to elucidate the role of additional hydration in cases with hyperamylasemia after ERCP.

Methods: This retrospective study included patients without a previous history of ERCP who developed hyperamylasemia three hours after the index ERCP in two centers. Patients were divided into a hydration group (with additional hydration of Lactated Ringer's solution at a rate of 40-80 ml per hour) or a control group (without additional hydration). Using propensity score matching, clinical outcomes including an incidence and severity of PEP were compared between the matched hydration and control groups.

Results: A total of 399 patients were eligible for the current analysis and 109 patients for each group were selected after propensity score matching. Patient characteristics and endoscopic procedure details were well-balanced between the matched hydration and control groups. The incidences of overall PEP were not different between the two groups (42% vs. 45%, P=0.68), but the incidence of moderate or severe PEP was significantly lower in the matched hydration group (8.3% vs.22%, odds ratio 0.32; P=0.006). Hydration-related complication was not observed in both groups.

Conclusions: Additional hydration for patients with hyperamylasemia after ERCP reduced the incidence of moderate or severe PEP without a risk of volume overload.