The researchers determined whether prophylactic long-acting glyceryl trinitrate (GTN) could reduce the incidence of endoscopic retrograde cholangiopancreatography-induced pancreatitis.
GTN 2 mg sublingually 5 min before endoscopy
|British Journal of Surgery|
They published their findings in the September issue of the British Journal of Surgery.
One possible etiology of pancreatitis following ERCP is cannulation-induced spasm of the sphincter of Oddi and consequent pancreatic duct obstruction. Sublingual GTN has been shown to produce periampullary sphincter relaxation.
A total of 186 patients who presented for elective ERCP were enrolled in the randomized double-blind study. Prophylactic treatment with GTN (2 mg given sublingually 5 minutes before endoscopy) was compared with placebo.
The primary endpoint was the occurrence of pancreatitis within 24 hours. This was defined as a serum amylase concentration greater than 1000 units/ml, in association with a visual analogue pain score of more than 5.
The team found that the incidence of pancreatitis was lower in the GTN group compared with placebo (7/90 vs 17/96).
Mean serum amylase values were similar in the two groups.
The protective effect of GTN appeared to be highest in the diagnostic ERCP group (1/54 vs 10/66) and in the group in which cholangiography alone was performed (1/54 vs 8/57).
Investigator S. Sudhindran, of the Countess of Chester Health Park, concluded on behalf of fellow authors, "Prophylactic treatment with GTN reduces the incidence of pancreatitis following ERCP. However, it does not seem to reduce the extent of hyperamylasaemia or the severity of pancreatitis."