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Unnecessary to Extend Postpartum Antiviral Therapy in Pregnant Women With High Hepatitis B Viral Loads.

reduction in the need for dual therapy in these cases would help control costs. In the interest of cost control, the other major logistic issue that needs to be addressed with aggressive hydration as designed to be administered in the included studies is the length of time allotted peri-procedurally for hydration. The length (in hours) of the hydration regimens (both aggressive and standard) for 8 hours postprocedure in the recovery area would be prohibitively expensive to initiate in a tertiary or quaternary care center such as ours. The vast majority of patients undergoing ERCP do so as outpatients in most US centers: caring for them in a monitored bed for an additional 8 hours after their procedure or admitting to the hospital would be far from cost effective compared with the current recovery time, which does not exceed 2 hours in the vast majority of cases. What we have adapted in our procedure lab in high risk patients, is administering 2L of LR (first bolus during ERCP and second in the recovery area). This way an average 70 kg patient receives double the amount of fluids compared with the standard hydration group in the included studies without having to prolong subject’s recovery time. In conclusion, we will find out in the near future whether indomethacin alone versus pancreatic stents and indomethacin together is more efficient in preventing PEP. Additional studies are also needed to delineate the effect of aggressive hydration in this setting. Finally, designing studies to assess the efficacy of a shorter “aggressive” hydration: perhaps 2L of LR over approximately 2 to 3 hours, which will prevent inflating the costs of recovery, should be a priority in the near future.