Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography:A single-blind,multicenter,randomized controlled trialOACSTPCDMEDLINE
Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography:A single-blind,multicenter,randomized controlled trial
Background:Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography(ERCP),the benefits and safety of high-carbohydrate fluid diet(CFD)intake 2 h before ERCP remain unclear.This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients'recovery. Methods:This prospective,multicenter,randomized controlled trial involved 15 tertiary ERCP centers.A total of 1330 patients were randomized into CFD group(n=665)and fasting group(n=665).The CFD group received 400 mL of maltodextrin orally 2 h before ERCP,while the control group abstained from food/water overnight(＞6 h)before ERCP.All ERCP procedures were performed using deep sedation with intravenous propofol.The investigators were blinded but not the patients.The primary outcomes included postoperative fatigue and abdominal pain score,and the secondary outcomes included complications and changes in metabolic indicators.The outcomes were analyzed according to a modified intention-to-treat principle. Results:The post-ERCP fatigue scores were significantly lower at 4 h(4.1±2.6 vs.4.8±2.8,t=4.23,P＜0.001)and 20 h(2.4±2.1 vs.3.4±2.4,t=7.94,P＜0.001)in the CFD group,with least-squares mean differences of 0.48(95％confidence interval[CI]:0.26-0.71,P＜0.001)and 0.76(95％CI:0.57-0.95,P＜0.001),respectively.The 4-h pain scores(2.1±1.7 vs.2.2±1.7,t=2.60,P=0.009,with a least-squares mean difference of 0.21[95％CI:0.05-0.37])and positive urine ketone levels(7.7％[39/509]vs.15.4％[82/533],x2=15.13,P＜0.001)were lower in the CFD group.The CFD group had significantly less cholangitis(2.1％[13/634]vs.4.0％[26/658],x2=3.99,P=0.046)but not pancreatitis(5.5％[35/634]vs.6.5％[43/658],x2=0.59,P=0.444).Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla(odds ratio[OR]:0.61,95％CI:0.39-0.95,P=0.028)in the multivariable models. Conclusion:Ingesting 400 mL of CFD 2 h before ERCP is safe,with a reduction in post-ERCP fatigue,abdominal pain,and cholangitis during recovery.
Wenbo Meng;Yingmei Shao;Jijun Zhang;Ping Yue;Lei Zhang;Kexiang Zhu;Xiaoliang Zhu;Hui Zhang;Senlin Hou;Kailin Cai;Hao Sun;Joseph W.Leung;Ping Xue;Wei Liu;Haiping Wang;Li Zhang;Songming Ding;Zhiqing Yang;Ming Zhang;Hao Weng;Qingyuan Wu;Bendong Chen;Zhenyu Wang;Tiemin Jiang;Yingkai Wang;Lichao Zhang;Ke Wu;Xue Yang;Zilong Wen;Chun Liu;Long Miao;Zhengfeng Wang;Jiajia Li;Qiyong Li;Xiaowen Yan;Fangzhao Wang;Lingen Zhang;Mingzhen Bai;Ningning Mi;Xianzhuo Zhang;Wence Zhou;Jinqiu Yuan;Azumi Suzuki;Kiyohito Tanaka;Leida Zhang;Jiankang Liu;Ula Nur;Elisabete Weiderpass;Xun Li;Kai Zhang;Xuefeng Wang;Meng Wang;Qi Wang
Department of General Surgery,The First Hospital of Lanzhou University,Lanzhou,Gansu 730000,China||Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province,Lanzhou,Gansu 730000,ChinaDepartment of Hepatobiliary & Hydatid,Digestive and Vascular Surgery Center,Xinjiang Key Laboratory of Echinococcosis and Liver Surgery Research,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830000,ChinaDepartment of Hepatobiliary and Pancreatic Surgery,The First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030000,ChinaDepartment of General Surgery,The Second Hospital of Lanzhou University,Lanzhou,Gansu 730000,ChinaDepartment of Biliopancreatic Endoscopic Surgery,The Second Hospital of Hebei Medical University,Shijiazhuang,Hebei 050000,ChinaGastrointestinal Surgery Department,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430000,ChinaDepartment of Hepatobiliary Surgery,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shaanxi 710000,ChinaDivision of Gastroenterology and Hepatology,UC Davis Medical Center,Sacramento,CA 95816,USADepartment of Hepatobiliary Surgery,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510260,ChinaDivision of Biliopancreatic Surgery,Department of General Surgery,Second Xiangya Hospital,Central South University,Changsha,Hunan 410000,ChinaKey Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province,Lanzhou,Gansu 730000,ChinaDepartment of Minimally Invasive Surgery,Tianjin Nankai Hospital,Tianjin 300100,ChinaDivision of Hepatobiliary and Pancreatic Surgery,Department of Surgery,Shulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University,Hangzhou,Zhejiang 310000,ChinaDepartment of Hepatobiliary Surgery,Southwest Hospital,Army Medical University,Chongqing 400000,ChinaHepatobiliary Surgery Department,Shandong Provincial Third Hospital,Jinan,Shandong 250000,ChinaDepartment of General Surgery,Xinhua Hospital,Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai Key Laboratory of Biliary Tract Disease Research,Shanghai 200000,ChinaDepartment of Hepatobiliary and Pancreatic Surgery,The First Hospital of Jilin University,Changchun,Jilin 130000,ChinaDepartment of Hepatobiliary Surgery,The General Hospital of Ningxia Medical University,Yinchuan,Ningxia 750000,ChinaDepartment of General Surgery,The First Hospital of Lanzhou University,Lanzhou,Gansu 730000,ChinaThe First Clinical Medical College of Lanzhou University,Lanzhou,Gansu 730000,ChinaClinical Research Centre,Scientific Research Centre,The Seventh Affiliated Hospital,Sun Yat-sen University,Shenzhen,Guangdong 518000 ChinaDepartment of Gastroenterology,Hamamatsu Medical Center,Hamamatsu 9800021,JapanDepartment of Gastroenterology,Kyoto Second Red Cross Hospital,Kyoto 201101,JapanCardiovascular Division,Brigham and Women's Hospital,Harvard Medical School,Boston,MA 02115,USADepartment of Public Health,College of Health Sciences,Qatar University,Doha 2713,Qatarinternational Agency for Research on Cancer(IARC),Lyon 69000,France
Endoscopic retrograde cholangiopancreatographyERCPCarbohydrateFastingSafetyComplicationsEnhanced recovery after surgeryRandomized controlled trial
《中华医学杂志（英文版）》 2024 (012)
1437-1446 / 10
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