Does restricting fluid volume impact post-ERCP pancreatitis in patient with heart disease?
Ko Tomishima1, Shigeto Ishii2, Toshio Fujisawa2, Noboru Yatagai1, Daishi Kabemura1, Sho Sato3, Nozomi Amano3, Ayato Murata3, Hironori Tsuzura3, Shunsuke Sato3, Kouhei Matsumoto1, Yuji Shimada3, Takuya Genda3, Akihito Nagahara1, Hiroyuki Isayama2
1 Department of Gastroenterology, Graduate School of Medicine, Juntendo University; Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Tokyo, Japan
2 Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
3 Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Tokyo, Japan
Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo - 113-8421
Source of Support: None, Conflict of Interest: None
Methods: Two hundred and forty seven of 480 patients with naïve papilla undergoing therapeutic ERCP between April 2013 and March 2018 were enrolled for the study. The following patient characteristics were investigated: age, sex, body mass index, previous diseases (heart disease, renal failure, cerebrovascular disorders, coexisting malignancy and pulmonary disease), history of PEP, common bile duct diameter, diverticula and volume of fluid infused 24 hours after the procedure. All ERCP cases had naïve papilla and had undergone treatment.
Results: The incidence of PEP was 8.5%. Significant differences were observed in the volume of fluid infused between patients without and with a history of heart disease (1,380 vs. 1,755 mL). The mean volume of the infused fluid was significantly lower in the PEP than non-PEP group (1,483 vs. 1,688 mL, P = 0.02). Moreover, PEP incidence differed according to a fluid infusion cutoff of 1,000 mL (7 vs. 11 cases of PEP in those with ≦1,000 mL and >1,000 mL fluid volume, respectively, P < 0.001).
Conclusion: Restricted fluid volume was a newly identified risk factor for PEP, particularly in patients with heart and renal diseases as comorbidities.