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 22 April 2018

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News

Cannulation of pancreatic duct at ERCP in pancreas divisum

Synthetic porcine secretin is useful in facilitating cannulation of the minor papilla in patients with pancreas, finds a research team in the May issue of Gastrointestinal Endoscopy.

News image

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Secretin stimulates secretion of water and bicarbonate from pancreatic ductal cells. It is a 27 amino acid polypeptide released in response to duodenal luminal acidification.

Secretin is used to facilitate pancreatic duct cannulation, but has not been approved for this indication.

In the past the only secretin available for clinical was a biologically derived compound extracted from porcine duodenums.

In this study, researchers from the United States compared synthetic porcine secretin with saline for the facilitation of minor papilla cannulation in patients with pancreas divisum.

The research team performed a multicenter, prospective, randomized, placebo-controlled, double-blind, comparative trial.

Cannulation was successful in 89% of patients who received synthetic porcine secretin.
Gastrointestinal Endoscopy

They enrolled 29 patients (7 men, 22 women) with pancreas divisum, in whom minor papilla cannulation was initially unsuccessful.

The team administered either saline solution or synthetic porcine secretin.

If the minor papilla orifice and/or pancreatic juice flow was noted, cannulation was attempted and success or failure was documented. The team also recorded the time taken for successful cannulation.

However, if cannulation was unsuccessful, no juice flow was noted, or the orifice was not seen, the alternate agent was administered (phase 2).

The researchers achieved cannulation in 1 of 13 patients in phase 1 after the placebo was given, and in 13 of 16 patients following synthetic porcine secretin.

In phase 2 of the study, cannulation was achieved in all 12 patients after synthetic porcine secretin was given and in 0 of 3 patients after placebo.

Overall, the team found that cannulation was successful in 89% of patients who received synthetic porcine secretin and in 6% who received the placebo.

They determined that the mean time to cannulation was significantly greater for the placebo group (4.75 minutes), than for the secretin (2.63 minutes).

The researchers did not identify any adverse events directly attributable to synthetic porcine secretin administration.

Dr Benedict Devereaux's team concluded, "This study confirmed the use and safety of synthetic porcine secretin in facilitating cannulation of the minor papilla in patients with pancreas divisum in whom cannulation was difficult".

"Use of this agent has the potential to further increase the cannulation success rate in this group of patients".

Gastrointest Endosc 2003; 57: 643-7
28 April 2003

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