[Does the use of fentanyl make Vater's ampulla cannulation difficult? A prospective and comparative study].
BACKGROUND
Fentanyl is a synthetic opioid with excellent results in perioperative analgesia. It is commonly used for proximal and distal gastrointestinal endoscopic procedures, but its contracting action on the sphincter of Oddi, similar to that of morphine, makes its use for endoscopic cholangiopancreatography (ERCP) controversial.


OBJECTIVE
To determinate if intravenous fentanyl as part of deep sedation hinders the cannulation of Vater's papilla during ERCP.


METHODS
Prospective, comparative, randomized and double-blind trial that enrolled patients undergoing ERCP in 2008, > 18 years old, without previous endoscopic or surgical procedures related with Vater s papilla. Patients were randomized into two groups: patients in whom ERCP was performed with intravenous propofol (group A), and patients in whom the procedure was performed with intravenous fentanyl and propofol (group B). Gender, age, comorbid conditions, reasons for referral, difficulty of cannulation, diagnosis, therapeutic procedures, procedure time and endoscopic complications were all documented.


RESULTS
432 were included: 214 in group A and 218 in group B. Both groups were similar in relation with demographic characteristics, time of sedation and endoscopic procedure. Difficulty in cannulation had not a statistical significance (p = 0.163). The administered dose of propofol were less for group B (p < 0.001). No procedure-related mortality was documented.


CONCLUSIONS
The combination of fentanyl and propofol may be used during ERCP, since it does not hinder the cannulation of Vater's papilla.
Güitrón-Cantú
A
A
Departamento de Endoscopia Digestiva, Hospital de Especialidades UMAE N° 71 Instituto Mexicano del Seguro Social, Torreón, Coahuila, México. aguitron@prodigy.net.mx
Adalid-Martínez
R
R
Gutiérrez-Bermúdez
J A
JA
Segura-López
F K
FK
García Vázquez
A
A
D014670:Ampulla of Vater / Q000187:drug effects*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D054810:Deep Sedation / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D000701:Analgesics, Opioid; D005283:Fentanyl