Acetate-Buffered Fluid Offers No Advantage Over Lactated Ringer’s in Post-ERCP Pancreatitis. UEG Journal | September 2026
Introduction:
Aggressive intravenous hydration can reduce post-ERCP pancreatitis (PEP), with lactated Ringer’s (LR) commonly preferred. This trial tested whether an acetate-buffered balanced crystalloid provides better PEP prevention in moderate-to-high-risk patients undergoing ERCP.
Why was this study needed?
PEP remains the most common major complication of ERCP.
Balanced crystalloids may differ in their metabolic and anti-inflammatory effects.
The optimal fluid type and duration of hydration remain uncertain.
Key Findings:
813 patients with native papillae were randomized to LR or acetate-buffered crystalloid.
PEP occurred in 12.4% with LR vs 11.5% with acetate-buffered fluid—no meaningful difference.
No severe PEP or fluid-overload events occurred.
68% of asymptomatic patients completed hydration after 4 hours, rather than continuing for 8 hours.
The findings support LR as an appropriate hydration fluid; switching to acetate offers no additional benefit.
A shorter, symptom-guided hydration strategy is promising but requires further validation.
Importantly, rectal NSAIDs were unavailable in this study, limiting applicability where standard NSAID prophylaxis is routinely used.
Bottom Line:
Acetate-buffered fluid does not outperform lactated Ringer’s for PEP prevention. The more interesting signal is that selected asymptomatic patients may safely complete hydration earlier.
