Sublingual L-hyoscyamine for duodenal antimotility during ERCP: a prospective randomized double-blinded study.
BACKGROUND
ERCP is often made difficult by duodenal motility. Glucagon is typically used to inhibit this motility. L-hyoscyamine is an antimuscarinic, anticholinergic agent shown to be a feasible intravenous alternative to glucagon.


OBJECTIVE
Demonstrate whether pre-ERCP sublingual L-hyoscyamine reduces the amount of glucagon required to complete ERCP.


METHODS
Randomized, double-blinded clinical trial of 200 participants assigned to receive L-hyoscyamine 0.5 mg or a placebo sublingually before ERCP. Comparative costs were determined.


METHODS
Tertiary referral university hospital in the intermountain west.


METHODS
Mix of inpatients and outpatients.


METHODS
The amount of supplemental glucagon required to complete ERCP was recorded, along with procedural outcomes and adverse effects.


RESULTS
The 2 groups (101 L-hyoscyamine, 99 placebo) were equally matched in terms of patient and procedure characteristics. There was a decrease in the amount of glucagon required to complete ERCP in the L-hyoscyamine group versus the placebo group, but the reduction was not statistically significant. No differences in complication rates, procedural difficulty, success rates, adverse drug effects, or patient disposition existed between the L-hyoscyamine and placebo groups.


CONCLUSIONS
Procedures were performed by more than 1 endoscopist, and rescue glucagon was administered at the sole discretion of the endoscopist; this introduced variation in glucagon administered among the participants.


CONCLUSIONS
Preprocedure administration of sublingual L-hyoscyamine did not reduce the amount of glucagon required to complete ERCP.
Lynch
Christopher R
CR
Division of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Khandekar
Suresh
S
Lynch
Scott M
SM
Disario
James A
JA
D000286:Administration, Sublingual; D001285:Atropine / Q000008:administration & dosage*; D001660:Biliary Tract Diseases / Q000175:diagnosis; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004386:Duodenum / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D005769:Gastrointestinal Motility / Q000187:drug effects*; D005934:Glucagon / Q000008:administration & dosage; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage*; D010182:Pancreatic Diseases / Q000175:diagnosis; D011446:Prospective Studies; D015203:Reproducibility of Results
D005765:Gastrointestinal Agents; D018727:Muscarinic Antagonists; D001285:Atropine; D005934:Glucagon