Ravi Teja Pasam, MBBS, MPH1, Kanwal Bains, MD2, Srilekha Chava, MBBS1, Arindam Bagga, 3 1Wentworth-Douglass Hospital, Dover, NH; 2Banner - University of Arizona Tucson, Tucson, AZ; 3Johns Hopkins University, Baltimore, MD Introduction: Post-ERCP pancreatitis (PEP) is one of the common adverse events of ERCP. Aggressive hydration is one of the guideline-recommended strategies for PEP prophylaxis. However, the effect of the fluid type on PEP has been studied only in a few head-to-head randomized control trials (RCTs). We conducted a component network meta-analysis (CNMA) to assess the relative efficacy of lactated ringer’s (LR) and normal saline (NS) for PEP prophylaxis. Methods: A comprehensive review of MEDLINE and Cochrane databases was conducted for RCTs assessing aggressive hydration with LR or NS. LR and NS could be evaluated alone or in combination with other interventions, with no specific selection criteria of the comparison groups. The ‘netmeta’ package was used to conduct random-effects, frequentist component network meta-analysis (CNMA). CNMA allows for assessing the individual contribution of a component in a multi-component intervention. Heterogeneity was evaluated with an I2 statistic. Transitivity was assessed by testing for inconsistency between direct and indirect evidence using standard network meta-analysis (SNMA). Risk ratio (RR) and 95% confidence interval (95% CI) were reported. Results: A total of 15 studies (3,419 patients) were included in the study. The mean age of the patients was 52.87 years (SD: 14.85) and 44.90% of them were males. LR and NS were evaluated in thirteen and five studies, respectively. NS and LR were directly compared in three studies. Figure 1 has the network graph for the analysis. The risk of PEP was not significantly different between LR and NS in CNMA (RR: 0.66; 95% CI: 0.43-1.01) (Figure 2). There was no evidence of substantial heterogeneity (I2: 19.8%). There was no evidence of inconsistence when an SNMA was performed (p-value: 0.90). Discussion: Current data does not demonstrate any significant differences in PEP rates between aggressive hydration with LR and NS. Additional head-to-head trials are required to assess the relative efficacy of LR and NS in preventing PEP.
Figure: Figure 1. Network graph. LR: Lactated ringer's; NS: Normal saline; PR: Per rectal
Figure: Figure 2. Forest plot comparing interventions to aggressive hydration with normal saline. LR: Lactated ringer's; NS: Normal saline; PR: Per rectal
Disclosures: Ravi Teja Pasam indicated no relevant financial relationships. Kanwal Bains indicated no relevant financial relationships. Srilekha Chava indicated no relevant financial relationships. Arindam Bagga indicated no relevant financial relationships.
Ravi Teja Pasam, MBBS, MPH1, Kanwal Bains, MD2, Srilekha Chava, MBBS1, Arindam Bagga, 3. P0046 - Lactated Ringer’s vs Normal Saline for Post-ERCP Pancreatitis Prophylaxis: Results of a Component Network Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
