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The secret (GTN) of successful ERCP cannulation: a prospective randomised controlled study
A Ghori1, M Hallisey, C Nwokolo
1Department of Surgery and Gastroenterology, Walsgrave Hospital, Coventry.
Background:
A key step for success at endoscopic retrograde cholangio-pancreatography (ERCP) is cannulation of the sphincter of Oddi. This prospective randomised controlled study was conducted to assess the effect of glyceryl trinitrate (GTN) on ease of cannulation.
Method:
Two hundred and fifty four patients undergoing ERCP were randomised into two groups, 126 controls and 128 pre-treated with GTN.
Result:
There were 29 cannulation failures in the whole group (overall failure rate of 11.4%). Failure was significantly less common in the GTN group, 7.03% (9/128) as compared with 15.8% (20/126) in the control group (p=0.0002). Deep cannulation was desired but not achieved in 45/200 patients (22.5%) Of these, 18.4% (19/103) were in the GTN group versus 26.8% (26/97) in the control group. This pattern of difference applied to both trained and trainee endoscopists. No significant side effects of GTN were noticed.
Conclusion:
GTN appears to be safe and effective in improving ERCP success rate. We recommend its routine use.
