Transdermal glyceryl trinitrate for prevention of post-ERCP pancreatitis: A randomized double-blind trial.
BACKGROUND
Pancreatic sphincter hypertension increases the risk of pancreatitis in patients undergoing ERCP. Glyceryl trinitrate reduces sphincter of Oddi pressure. This study tested the hypothesis that transdermal glyceryl trinitrate could be effective in the prevention of post-ERCP pancreatitis.


METHODS
One hundred forty-four patients undergoing ERCP were randomized: 71 received a 15-mg glyceryl trinitrate patch (glyceryl trinitrate group) and 73 a placebo patch (control group).


RESULTS
In the control group, post-ERCP pancreatitis developed in 11 patients versus 3 in the glyceryl trinitrate group (p < 0.05). Twenty-four hour to baseline serum amylase and lipase ratios were lower in the glyceryl trinitrate group (respectively, 3.6 vs. 7.5, p < 0.05; and 5.3 vs. 27.7, p < 0.05). In a multivariate analysis, glyceryl trinitrate patch and the number of pancreatic injections, but not endoscopic sphincterotomy, were independent risk factors for post-ERCP pancreatitis.


CONCLUSIONS
The results of this study suggest that use of a transdermal glyceryl trinitrate patch protects against post-ERCP pancreatitis.
Moretó
Manuel
M
Servicio de Gastroenterología, Hospital de Cruces, Barakaldo, Spain.
Zaballa
Manuel
M
Casado
Ignacio
I
Merino
Olga
O
Rueda
Miguel
M
Ramírez
Kléber
K
Urcelay
Raquel
R
Baranda
Amaia
A
D000279:Administration, Cutaneous; D000368:Aged; D000681:Amylases / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008049:Lipase / Q000097:blood; D008297:Male; D015999:Multivariate Analysis; D005996:Nitroglycerin / Q000627:therapeutic use*; D010195:Pancreatitis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications; D012307:Risk Factors; D009803:Sphincter of Oddi / Q000187:drug effects; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*
D014665:Vasodilator Agents; D008049:Lipase; D000681:Amylases; D005996:Nitroglycerin