The secret (GTN) of successful ERCP cannulation: a prospective randomised controlled study.
BACKGROUND
A key step for success at endoscopic retrograde cholangio-pancreatography (ERCP) is cannulation of the sphincter of Oddi. This prospective randomised controlled study was conducted to assess the effect of glyceryl trinitrate (GTN) on ease of cannulation.


METHODS
Two hundred and fifty four patients undergoing ERCP were randomised into two groups, 126 controls and 128 pre-treated with GTN.


RESULTS
There were 29 cannulation failures in the whole group (overall failure rate of 11.4%). Failure was significantly less common in the GTN group, 7.03% (9/128) as compared with 15.8% (20/126) in the control group (p=0.0002). Deep cannulation was desired but not achieved in 45/200 patients (22.5%) Of these, 18.4% (19/103) were in the GTN group versus 26.8% (26/97) in the control group. This pattern of difference applied to both trained and trainee endoscopists. No significant side effects of GTN were noticed.


CONCLUSIONS
GTN appears to be safe and effective in improving ERCP success rate. We recommend its routine use.
D000368:Aged; D002404:Catheterization / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use*; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D005996:Nitroglycerin