A Randomized Controlled Trial Of Preoperative Oral Carbohydrates(POC) In Enhanced Recovery After Surgery(ERAS) Of Endoscopic Retrograde Cholangiopancreatography(ERCP)

Objective: To evaluate the safety and enthusiasm of perioperative about drinking 400 ml slag-free carbohydrate at two hours before endoscopic retrograde cholangiopancreatography(ERCP)and provide evidence for ERCP perioperative diet management and enhanced recovery after surgery(ERAS)Methods: For prospective analysis of clinical data of patients undergoing ERCP treatment at the General Hospital of Ningxiang Medical University from June 01,2018 to October 31,2019,and a single-blind,randomized controlled trial was performed.Eligible patients receiving ERCP were randomized according to the ratio of 1: 1(produced by the random number table method).They were split into the control group(B)and the experimental group(A).In the group(A),patients would be allowed to drink all consumed 400 ml of warm(30-40 degrees Celsius)slag-free carbohydrate(lactulose)at the two hours before ERCP,while patients in the control group(B)had a regular fasting for more than six hours.All patients received pre-operative education and popularized the operation procedures to make patients fully prepared for thought and eliminate tension.Neither the surgeon nor the data analyst knew the patient grouping.Compare the two groups of patients with urine ketone body and urine specific gravity within half an hour before operation and within 24 hours after operation,with intragastric mucus residue during operation,with postoperative fatigue and pain,with postoperative pancreatitis,cholangitis,abdominal distension,nausea,vomiting and other complications,with the first voluntary feeding time after surgery,with blood glucose stability during perioperative period,with length of hospital stay and cost.The analysis follows the intentionality principle.Results: 1.In terms of patient basics: there were no significant differences between the two groups in terms of gender,basic disease prevalence,body mass index,surgical indications,preoperative fatigue,and surgical history(p> 0.05).2.In terms of safety: there was no significant difference in the amount of gastric mucus in the two groups during operation,and no adverse events such as cough and aspiration occurred during the operation.Postoperative pancreatitis and cholangitis in the two groups of patients had no significant difference in incidence(p> 0.05).3.In terms of positive treatment effect: The positive rate of urinary ketone body and urine specific gravity in group A was significantly lower than that in group B at half an hour before the operation(p<0.05).Among the patients with abdominal pain,bloating and nausea after operation,group A was significantly lower than group(p<0.05);Compared with patients in group B,the perioperative blood glucose of patients in group A was significantly stable(p<0.001),patients in group A recovered faster after physical,and mental fatigue and spent less in hospital(p<0.05).4.Other aspects: There was no significant difference in length of hospital stay and the infusion volume between the two groups of patients.Conclusion: 1.Drinking 400 ml warm carbohydrates at one time 2h before surgery is safe for ERCP surgery;2.Drinking 400 ml warm carbohydrates at one time 2h before surgery can help improve the perioperative insulin resistance status of patients and accelerate the patient's mental and physical recovery after surgery.And which also can relieve the symptoms of gastrointestinal dysfunction such as abdominal distension,abdominal pain and nausea caused by prolonged diet,surgical trauma and the effect of anesthetic drugs,and then promote the patient's postoperative recovery.