Added hydration has uncertain benefit over NSAIDs for preventing post-ERCP pancreatitis

A meta-analysis published in Endoscopy assessed whether aggressive intravenous hydration adds benefit to NSAIDs for preventing post-ERCP pancreatitis (PEP). Investigators searched MEDLINE, Scopus, and the Cochrane Library and included eight randomized controlled trials involving 1,903 adults undergoing ERCP. The primary analysis estimated pooled PEP risk ratios using a random-effects model.

Pooled arm-specific PEP incidence was 2.8% (95% CI 0.4%–6.7%) with combination prophylaxis and 7.6% (95% CI 5.2%–10.4%) with NSAIDs alone. The primary relative-risk estimate favored combination therapy but was statistically inconclusive (RR 0.66, 95% CI 0.40–1.08; I²=18%). The pooled risk difference was −3.8 percentage points (95% CI −6.3 to −1.4).

A REML/Hartung–Knapp analysis also remained inconclusive (RR 0.73, 95% CI 0.45–1.18), and trial sequential analysis showed that the required information size had not been reached. Thus, despite the favorable absolute risk difference, the available evidence does not establish superiority of adding aggressive hydration to NSAIDs. These findings concern the incremental benefit of hydration, rather than the efficacy of either prophylactic approach individually. This update is based on the abstract because the full text was inaccessible.