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Safety and efficacy of early feeding based on clinical assessment at 4 hours after ERCP: a prospective randomized controlled trial

Title
Safety and efficacy of early feeding based on clinical assessment at 4 hours after ERCP: a prospective randomized controlled trial
Author
박찬혁
Keywords
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY; RISK-FACTORS; BILE-DUCT; PANCREATITIS; SPHINCTEROTOMY; CANNULATION; COMPLICATIONS; METAANALYSIS; MULTICENTER; PREVENTION
Issue Date
2018-04
Publisher
MOSBY-ELSEVIER
Citation
GASTROINTESTINAL ENDOSCOPY, v. 87, no. 4, page. 1040-1049
Abstract
Background and Aims: The optimal timing of refeeding after ERCP is unknown. Some practices keep the patient fasting for 24 hours after ERCP, whereas others resume feeding earlier. We aimed to evaluate the risk of post-ERCP pancreatitis (PEP) in patients who initiate early feeding, based on their clinical assessment, including serum amylase testing performed at 4 hours after ERCP.Methods: Patients who were scheduled for ERCP were recruited. Patients without abdominal pain and tenderness and a serum amylase level within 1.5-fold the upper limit of normal at 4 hours after ERCP were randomly assigned to either the 4-hour fasting or 24-hour fasting group. Patients from the 4-hour fasting group started oral intake 4 hours after ERCP, whereas those from the 24-hour fasting group fasted for 24 hours after ERCP.Results: Among the 276 enrolled, PEP was identified in 3 (2.2%) from the 4-hour fasting group and in 5 (3.6%) from the 24-hour fasting group, with a rate difference of -1.4% (1-sided 97.5% confidence interval, -infinity to 2.5%). Four-hour fasting was non-inferior to 24-hour fasting in terms of PEP incidence. The total medical costs for treatment-related ERCP were significantly lower in the 4-hour fasting group than in the 24-hour fasting group (1157.20 +/- 311.90 vs 1311.20 +/- 410.70 U.S. dollars; P = .032).Conclusion: Early feeding in patients without abdominal pain and tenderness and a serum amylase level <1.5-fold the upper limit of normal at 4 hours after ERCP does not increase the incidence of PEP after ERCP and decreases medical costs. (Clinical trial registration number: KCT0002354.)
URI
https://www.giejournal.org/article/S0016-5107(17)32317-9/fulltexthttp://repository.hanyang.ac.kr/handle/20.500.11754/118487
ISSN
0016-5107; 1097-6779
DOI
10.1016/j.gie.2017.09.021
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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