title: Direct spraying of shakuyakukanzoto onto the duodenal papilla: a novel method for preventing pancreatitis following endoscopic retrograde cholangiopancreatography.
abstract: OBJECTIVE
  Topical epinephrine application to the duodenal papilla reduces spasm of the sphincter of Oddi and prevents acute pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). Shakuyakukanzoto (TJ-68) has an inhibitory effect on muscle contraction. Therefore, TJ-68 potentially allows the relaxation of the sphincter of Oddi, which can aid in the prevention of post-ERCP pancreatitis.
  
  
  METHODS
  Thirty-six patients planned for ERCP were divided into TJ-68 (n = 17) and control groups (n = 19). In the TJ-68 group, the TJ-68 solution was endoscopically sprayed directly onto the duodenal papilla of patients. To assess the effects of TJ-68, serum amylase levels were measured at 1 h and 1 day after ERCP and symptoms were evaluated.
  
  
  RESULTS
  The serum amylase levels at 1 h after ERCP were 273.6 ± 212.0 IU/l in the TJ-68 group and 428.7 ± 281.6 IU/l in the control group, showing a statistically significant difference (p = 0.036). The serum amylase levels at 24 h after ERCP were 230.0 ± 182.7 IU/l in the TJ-68 group and 497.4 ± 514.0 IU/l in the control group (p = 0.011). Post-ERCP pancreatitis was observed in 0 and 4 patients (21.1%) in the TJ-68 and control groups, respectively, which was not statistically significant (p = 0.11).
  
  
  CONCLUSIONS
  Direct TJ-68 solution application to the duodenal papilla significantly inhibited the elevation of serum amylase levels. However, the preventive effect regarding post-ERCP pancreatitis was not confirmed in this study.
authors: Department of Endoscopy, Toyama University Hospital, Toyama City, Japan.
authors: Haruka
authors: H
authors: Fujinami
authors: Shinya
authors: S
authors: Kajiura
authors: Takayuki
authors: T
authors: Ando
authors: Hiroshi
authors: H
authors: Mihara
authors: Ayumu
authors: A
authors: Hosokawa
authors: Toshiro
authors: T
authors: Sugiyama
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000187:drug effects*; D000681:Amylases / Q000097:blood; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004338:Drug Combinations; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage*; D005260:Female; D006035:Glycyrrhiza; D006801:Humans; D008297:Male; D008875:Middle Aged; D029596:Paeonia; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D009803:Sphincter of Oddi / Q000276:immunology
chemical_list: D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D004365:Drugs, Chinese Herbal; C038462:shakuyaku-kanzoh-toh; D000681:Amylases