A prospective, double-blind trial of somatostatin analog (octreotide) versus glucagon for the inhibition of small intestinal motility during endoscopic retrograde cholangiopancreatography.
BACKGROUND
Glucagon is effective when used as an antimotility agent during ERCP, but at high doses it may cause nausea and vomiting. Octreotide acetate, a long-acting synthetic analog of somatostatin, inhibits contractility of the small intestine and is generally well tolerated. The purpose of this study was to determine if octreotide given prior to ERCP reduced the requirement for glucagon and enhanced patient tolerance for the procedure.


METHODS
Patients undergoing ERCP (n = 100) performed for a variety of indications (but not sphincter of Oddi manometry) were randomly assigned to receive normal saline solution or octreotide at a total dose of 25 micrograms, 50 micrograms, or 100 micrograms diluted in normal saline solution prior to the procedure. Glucagon was subsequently administered (as needed, to inhibit intestinal motility) by endoscopists who were blinded to the test substance given prior to the procedure.


RESULTS
For all treatment groups, the dose of glucagon required to inhibit intestinal motility in patients who received octreotide prior to the procedure was not significantly different from the dose administered to patients who received normal saline solution. There was no significant difference in the incidence of nausea and vomiting when individual test groups were compared to the control group.


CONCLUSIONS
Nausea and vomiting after ERCP were uncommon in all treatment groups. Administration of octreotide prior to ERCP did not significantly reduce the dose of glucagon required to inhibit intestinal motility. Tolerance for ERCP was similar for patients given octreotide when compared with those given glucagon to inhibit small intestinal motility.
Department of Gastroenterology, Cleveland Clinic Foundation, Ohio, USA.
J
J
Van Dam
M F
MF
Catalano
D R
DR
Ferguson
D S
DS
Barnes
G
G
Zuccaro
M V
MV
Sivak
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016292:Procedural Sedation; D004311:Double-Blind Method; D005765:Gastrointestinal Agents / Q000494:pharmacology*; D005769:Gastrointestinal Motility / Q000187:drug effects*; D005934:Glucagon / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D007421:Intestine, Small / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D015282:Octreotide / Q000009:adverse effects / Q000494:pharmacology*; D011446:Prospective Studies; D013004:Somatostatin
D005765:Gastrointestinal Agents; D013004:Somatostatin; D005934:Glucagon; D015282:Octreotide