Does topical GTN on the sphincter of Oddi facilitate ERCP? A double-blind randomized control trial.
BACKGROUND
Endoscopic retrograde cholangio pancreatography (ERCP) is a technically challenging procedure. Glyceryl trinitrate (GTN) has been shown to reduce tone in the sphincter of Oddi (SO), cannulation of which is a rate-limiting factor. A double-blind randomized control trial was performed to assess whether topical GTN on the SO would facilitate cholangiography and/or bile duct cannulation.


METHODS
104 patients requiring ERCP for biliary symptoms were randomized into two groups, 52 controls pretreated with 5 ml 0.9% normal saline (NS) and 52 pretreated with 5 ml GTN (concentration 1 mg/ml).


RESULTS
There was no significant between the control group and the GTN group in primary cannulation rate (p = 0.76), time taken to cholangiography (p = 0.58), or time to cannulation (p = 0.43).


CONCLUSIONS
Topically administered GTN to the SO does not aid in obtaining a cholangiogram or cannulation during an ERCP.
Talwar
A
A
Department of General Surgery, Poole General Hospital, Longfleet Road, Dorset, BH15 2JB, United Kingdom. Anjay@onetel.com
Dare
C
C
Pain
J
J
D000287:Administration, Topical; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis; D004311:Double-Blind Method; D005260:Female; D042882:Gallstones / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D009803:Sphincter of Oddi; D014665:Vasodilator Agents / Q000008:administration & dosage*
D014665:Vasodilator Agents; D005996:Nitroglycerin