Post-ERCP pancreatitis is a recognized complication of ERCP and contributes significantly to patient’s morbidity, prolonged hospitalization and mortality. Optimizing fluid management strategies has been proposed as a means of improving clinical outcomes, but the impact of different fluid types and timing remains uncertain. This study aims to assess whether intravenous fluid type (Hartmann’s vs Normal Saline) and timing (Pre vs Post ERCP) were associated with pancreatitis severity or mortality among patients who developed post-ERCP pancreatitis at our distric general hospital. 

A retrospective observational study was conducted using data from April 2021 to April 2025. Information was obtained from Electronic Patient Records and Endoscopy Unit documentation. The Revised Atlanta Classification was used in the diagnosis of pancreatitis as well as in assessing the severity throughout the hospitalization. Intravenous fluid type and timing, along with ERCP indications and difficulty of the ERCP procedures, length of stay and mortality were all evaluated.

1,098 ERCP procedures were performed between April 2021 and April 2025. 33 cases (3.0%) met criteria for post-ERCP pancreatitis (PEP) with 20 inpatient procedures (61%) and 13 outpatients (39%). The majority of affected patients (73%) were older than 60 years. Regarding indications in patients with PEP, 14 ERCPs were undertaken for ductal stones, 11 for stent placement in pancreatic malignancy, 7 for stenting of benign or malignant ductal strictures, and 1 for a post-cholecystectomy bile leak. In terms of technical difficulty: 7 procedures required double-guidewire, 1 required pre-cut sphincterotomy, and 2 required both; all remaining cases were uncomplicated. Based on the Revised Atlanta Classification, 26 patients (79%) developed mild pancreatitis and 7 (21%) developed moderate/severe disease; all patients received intravenous fluids. Across patients with moderate/severe pancreatitis, the proportion of IV fluid types were as follows: Hartmann’s 3 patients, normal saline 2 patients, Hartmann’s and Normal Saline 1 patient, data unavailable 1 patient. In patients with mild pancreatitis, results were as follows: Hartmann’s 9 patients, Normal Saline 6 patients, Hartmann’s and Normal Saline 6 patients, Data unavailable in 5 patients. There was no significant association between fluid type and severity (Fisher–Freeman–Halton exact test, 4×2, p = 1.000). Fluid type was also not associated with 28-day mortality (p = 0.674); deaths occurred in patients receiving both Hartmann’s and Normal Saline (1/7, 14.3%), Hartmann’s only (1/12, 8.3%) or with undocumented fluid type (1/6, 16.7%), and in none of those who received normal saline only (0/8). Regarding timing, moderate/severe pancreatitis occurred in 5/26 (19.2%) patients receiving post-procedure fluids only, 0/1 (0%) receiving pre-procedure fluids only, and 2/6 (33.3%) receiving both pre- and post-procedure fluids, with no significant association between timing and severity (Fisher–Freeman–Halton exact test, 3×2, p = 0.677). Similarly, timing of fluids was not associated with 28-day mortality (post 2/26 [7.7%], pre 0/1, pre and post 1/6 [16.7%]; p = 0.523). 

Fluid Type + Timing vs Severity and Mortality

Across this four-year cohort, neither the type nor the timing of IV fluid administration demonstrated a statistically significant relationship with severity or mortality in post-ERCP pancreatitis. Although the overall mortality rate was low, the absence of a detectable effect highlights the need for larger prospective studies to determine whether targeted fluid strategies may confer benefit in preventing progression or complications of PEP.