Efficacy of peppermint oil as an antispasmodic during endoscopic retrograde cholangiopancreatography.
BACKGROUND
During endoscopic retrograde cholangiopancreatography (ERCP), hyoscine-N-butylbromide (Buscopan) or glucagon is used to inhibit duodenal motility. However, they may cause adverse effects. Peppermint oil has an antispasmodic effect and is used as a less hazardous antispasmodic during colonoscopy and upper gastrointestinal endoscopy. The purpose of the present paper was therefore to investigate peppermint as an antispasmodic for ERCP.


METHODS
Forty patients were enrolled prospectively. They were assigned to four groups according to the peppermint oil concentration and site of administration: group 1, 20 mL of 1.6% solution around duodenal papilla; group 2, 20 mL of 1.6% solution both to the antrum of the stomach and around the duodenal papilla; group 3, 20 mL of 3.2% solution around the duodenal papilla; and group 4, 3.2% solution both to the antrum and around the duodenal papilla. Glucagon or hyoscine-N-butylbromide was added when duodenal peristalsis was not adequately diminished. Sixteen patients undergoing ERCP with glucagon were employed as historical controls.


RESULTS
The ERCP was attempted in all except one patient in group 2 who had bleeding from invaded tumor to the duodenum. Peppermint administration equally reduced duodenal motility in the groups. Duodenal movement was none or mild in 69.2% of patients. The ERCP was successfully performed with peppermint alone in 91.4% of patients (37/39). Glucagon or hyoscine-N-butylbromide was needed in one patient each in groups 1 and 4. Serious complications related to peppermint oil did not occur. Inhibitory effect of peppermint appears to be identical to that of glucagon.


CONCLUSIONS
Duodenal relaxation was obtained with 20 mL of 1.6% peppermint oil solution in the duodenum, but additional administration may be required. Peppermint oil is useful as an antispasmodic agent for ERCP.
Yamamoto
Natsuyo
N
Department of Gastroenterology, University of Tokyo, Tokyo, Japan.
Nakai
Yousuke
Y
Sasahira
Naoki
N
Hirano
Kenji
K
Tsujino
Takeshi
T
Isayama
Hiroyuki
H
Komatsu
Yutaka
Y
Tada
Minoru
M
Tada
Mimoru
M
Yoshida
Haruhiko
H
Kawabe
Takao
T
Hiki
Naoki
N
Kaminishi
Michio
M
Kurosaka
Hanzo
H
Omata
Masao
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002086:Butylscopolammonium Bromide / Q000009:adverse effects / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004386:Duodenum / Q000187:drug effects / Q000378:metabolism; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects; D005934:Glucagon / Q000627:therapeutic use; D006801:Humans; D008297:Male; D036142:Mentha piperita; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D010276:Parasympatholytics / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D010938:Plant Oils / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D012189:Retrospective Studies; D013035:Spasm / Q000188:drug therapy*
D018727:Muscarinic Antagonists; D010276:Parasympatholytics; D010938:Plant Oils; D002086:Butylscopolammonium Bromide; D005934:Glucagon; C015424:peppermint oil