Lactated Ringer’s Solution at a Standard Infusion Rate in Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis Prevention: A Retrospective Comparative Study

BACKGROUND: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is a common complication, and its prevention remains challenging. Although aggressive infusion of lactated Ringer's solution (hereafter Lactated Ringer's) has shown preventive effects, the efficacy of standard infusion rates remains unclear. AIM: To evaluate whether lactated Ringer's administered at a standard rate reduces the incidence or severity of post-ERCP pancreatitis compared with non-lactated Ringer's solutions. METHODS: This single-center retrospective study compared patients who received non-lactated Ringer's solutions before January 2019 with those who received lactated Ringer's after January 2019, at a standard rate. The outcomes were post-ERCP pancreatitis incidence, severity, C-reactive protein (CRP) level, and systemic inflammatory response syndrome (SIRS). RESULTS: Of 1194 patients included (median age, 71 years; 60% male), pancreatitis occurred in 5.6% (30/529) of the non-lactated Ringer's group and 5.3% (35/665) of the lactated Ringer's group (P = 0.76). Severe or moderately severe pancreatitis occurred in six patients each in both groups (approximately 1%). Mean CRP level at 24 h was similar between the groups (1.26 vs. 1.44 mg/dL, P = 0.75), and SIRS rates at 24/48 h did not differ significantly (P = 0.61 and 1.00). Multivariate analysis identified pancreatic injection, naïve papilla, and female sex as independent risk factors; fluid type was not associated with outcome (OR 1.09, P = 0.76). CONCLUSIONS: Lactated Ringer's at a standard infusion rate did not reduce the incidence or severity of post-ERCP pancreatitis compared with a non-lactated Ringer's solution. Further research is required to optimize fluid therapy for preventing this complication.