Chinese Medical Journal (Jun 2024)
Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography: A single-blind, multicenter, randomized controlled trial
- Wenbo Meng,
- Joseph W. Leung,
- Zhenyu Wang,
- Qiyong Li,
- Leida Zhang,
- Kai Zhang,
- Xuefeng Wang,
- Meng Wang,
- Qi Wang,
- Yingmei Shao,
- Jijun Zhang,
- Ping Yue,
- Lei Zhang,
- Kexiang Zhu,
- Xiaoliang Zhu,
- Hui Zhang,
- Senlin Hou,
- Kailin Cai,
- Hao Sun,
- Ping Xue,
- Wei Liu,
- Haiping Wang,
- Li Zhang,
- Songming Ding,
- Zhiqing Yang,
- Ming Zhang,
- Hao Weng,
- Qingyuan Wu,
- Bendong Chen,
- Tiemin Jiang,
- Yingkai Wang,
- Lichao Zhang,
- Ke Wu,
- Xue Yang,
- Zilong Wen,
- Chun Liu,
- Long Miao,
- Zhengfeng Wang,
- Jiajia Li,
- Xiaowen Yan,
- Fangzhao Wang,
- Lingen Zhang,
- Mingzhen Bai,
- Ningning Mi,
- Xianzhuo Zhang,
- Wence Zhou,
- Jinqiu Yuan,
- Azumi Suzuki,
- Kiyohito Tanaka,
- Jiankang Liu,
- Ula Nur,
- Elisabete Weiderpass,
- Xun Li,
- Ting Gao,
- Xiuyuan Hao
Affiliations
- Wenbo Meng
- 1 Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Joseph W. Leung
- 3 Division of Gastroenterology and Hepatology, UC Davis Medical Center, Sacramento, CA 95816, USA
- Zhenyu Wang
- 4 Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin 300100, China
- Qiyong Li
- 5 Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Hangzhou, Zhejiang 310000, China
- Leida Zhang
- 6 Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing 400000, China
- Kai Zhang
- 7 Hepatobiliary Surgery Department, Shandong Provincial Third Hospital, Jinan, Shandong 250000, China
- Xuefeng Wang
- 8 Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Biliary Tract Disease Research, Shanghai 200000, China
- Meng Wang
- 9 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130000, China
- Qi Wang
- 10 Department of Hepatobiliary Surgery, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750000, China
- Yingmei Shao
- 11 Department 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, China
- Jijun Zhang
- 12 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030000, China
- Ping Yue
- 1 Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Lei Zhang
- 1 Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Kexiang Zhu
- 1 Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Xiaoliang Zhu
- 1 Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Hui Zhang
- 13 Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Senlin Hou
- 14 Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
- Kailin Cai
- 15 Gastrointestinal Surgery Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
- Hao Sun
- 16 Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
- Ping Xue
- 17 Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China
- Wei Liu
- 18 Division of Biliopancreatic Surgery, Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
- Haiping Wang
- 2 Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
- Li Zhang
- 4 Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin 300100, China
- Songming Ding
- 5 Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Hangzhou, Zhejiang 310000, China
- Zhiqing Yang
- 6 Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing 400000, China
- Ming Zhang
- 7 Hepatobiliary Surgery Department, Shandong Provincial Third Hospital, Jinan, Shandong 250000, China
- Hao Weng
- 8 Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Biliary Tract Disease Research, Shanghai 200000, China
- Qingyuan Wu
- 9 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130000, China
- Bendong Chen
- 10 Department of Hepatobiliary Surgery, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750000, China
- Tiemin Jiang
- 11 Department 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, China
- Yingkai Wang
- 12 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030000, China
- Lichao Zhang
- 14 Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
- Ke Wu
- 15 Gastrointestinal Surgery Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000, China
- Xue Yang
- 16 Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
- Zilong Wen
- 17 Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, China
- Chun Liu
- 18 Division of Biliopancreatic Surgery, Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan 410000, China
- Long Miao
- 1 Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Zhengfeng Wang
- 1 Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Jiajia Li
- 2 Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
- Xiaowen Yan
- 2 Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou, Gansu 730000, China
- Fangzhao Wang
- 1 Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Lingen Zhang
- 1 Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Mingzhen Bai
- 19 The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
- Ningning Mi
- 19 The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
- Xianzhuo Zhang
- 19 The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
- Wence Zhou
- 13 Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Jinqiu Yuan
- 20 Clinical Research Centre, Scientific Research Centre, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518000 China
- Azumi Suzuki
- 21 Department of Gastroenterology, Hamamatsu Medical Center, Hamamatsu 9800021, Japan
- Kiyohito Tanaka
- 22 Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto 201101, Japan
- Jiankang Liu
- 23 Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Ula Nur
- 24 Department of Public Health, College of Health Sciences, Qatar University, Doha 2713, Qatar
- Elisabete Weiderpass
- 25 International Agency for Research on Cancer (IARC), Lyon 69000, France.
- Xun Li
- 1 Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Ting Gao
- Xiuyuan Hao
- DOI
- https://doi.org/10.1097/CM9.0000000000002820
- Journal volume & issue
-
Vol. 137,
no. 12
pp. 1437 – 1446
Abstract
Abstract. 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], χ2 = 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], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 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. Trail Registration:. ClinicalTrials.gov, No. NCT03075280.
