- The WATERLAND study concludes that there are no clinical differences between the use of normal saline and Ringer’s lactate during the first hours of hospital admission
- WATERLAND has been recognized among the most outstanding works at the Digestive Disease Week 2026 congress
Alicante (23.05.26).– The Alicante Institute for Health and Biomedical Research (ISABIAL) has led WATERLAND, an international clinical trial—the largest to date in terms of both the number of patients recruited and the number of participating countries—conducted on acute pancreatitis. The research focused on fluid therapy, one of the key treatments during the first hours of hospital admission for these patients, based on the administration of intravenous fluids to maintain proper hydration and ensure that organs function correctly.
The clinical trial compared the effectiveness of the two fluids most commonly used in hospitals worldwide for the management of acute pancreatitis: normal saline and Ringer’s lactate. The results showed that there are no clinically relevant differences between the two fluids for treating this condition, in aspects such as pain intensity, length of hospital stay, the appearance of local complications, organ failure, or mortality.
The trial was led and coordinated by Dr. Enrique de Madaria, Scientific Deputy Director for Projects at ISABIAL and gastroenterologist in the Digestive System Department of Doctor Balmis University General Hospital. Nearly 800 patients from 47 hospital centers in 18 countries across five continents participated in the study, including Australia, China, India, Pakistan, the United States, and various European, African, and Latin American countries.
Dr. de Madaria explained that ‘with nearly 800 patients recruited, WATERLAND becomes the international clinical trial with the largest number of participants ever conducted in acute pancreatitis, and the most international one to date’.
According to researcher Enrique de Madaria, ‘although the study did observe small biological advantages associated with the use of Ringer’s lactate—such as lower blood acidosis and a reduction in inflammatory markers—these differences do not translate into a significant improvement in the clinical course of patients’.
Therefore, the results of the study have shown that there are no clinically relevant differences between the two fluids, which will require a reconsideration of the current recommendations in international clinical guidelines on fluid therapy in acute pancreatitis, as these currently position Ringer’s lactate as the fluid of choice due to its potential ability to improve patient outcomes.
Four years of coordinated work
The WATERLAND clinical trial, launched in 2022, has involved four years of continuous work from its design and implementation to the current phase of scientific publication. One of the project’s main milestones was completing the recruitment of nearly 800 patients in just a year and a half. ‘This is an unprecedented achievement in acute pancreatitis within an international clinical trial of this nature and scale’, emphasized Dr. de Madaria.
The researcher also emphasized the involvement of the multidisciplinary team working at Doctor Balmis University General Hospital. The participation of residents, nursing staff, and professionals from the Biliopancreatic Unit has been especially crucial, as their collaboration was essential for patient recruitment and clinical follow‑up.
The international coordination of the project was led by pharmacist Alicia Vaillo, who was responsible for managing, monitoring, and facilitating communication among all participating centers. Her work ensured the consistency of the protocol and the pace of patient recruitment that made it possible to successfully complete this international trial.
Dr. Enrique de Madaria presented the results of the WATERLAND trial at the North American gastroenterology congress ‘Digestive Disease Week 2026’, recently held in Chicago (United States). During the congress—considered the most important scientific meeting worldwide in the digestive field—the study was recognized as one of the six most relevant works internationally in gastroenterology.
