S53 Lactated Ringer’s vs Normal Saline for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Pancreatitis Prophylaxis: Results of a Component Network Meta-Analysis

Introduction: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is 1 of the common adverse events of endoscopic retrograde cholangiopancreatography pancreatitis. Aggressive hydration is 1 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 controlled trials. 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 randomized controlled trials 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 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 men. LR and NS were evaluated in thirteen and 5 studies, respectively. NS and LR were directly compared in 3 studies. Figure 1 has the network graph for the analysis [Figures presented at ACG annual meeting]. The risk of PEP was not significantly different between LR and NS in CNMA (RR: 0.66; 95% CI: 0.43-1.01). 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). Conclusion: 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.