Inhibitory Effect of Lidocaine on Duodenal Peristalsis During Endoscopic Retrograde Cholangiopancreatography: A...

Conventional antispasmodics used during endoscopic retrograde cholangiopancreatography (ERCP), such as hyoscine butylbromide and glucagon, are often contraindicated in elderly patients with comorbidities. This trial aimed to assess the efficacy of lidocaine for inhibiting duodenal peristalsis during ERCP.

This multicenter randomized controlled trial enrolled 40 elderly patients (aged 65-89 years) who were scheduled to undergo ERCP. Patients were randomly assigned to the lidocaine group or the control group using a computer-generated sequence with stratification by age and sex. The lidocaine group (n = 19) received 2% lidocaine jelly mixed with saline, while the control group (n = 21) received a placebo jelly mixed with saline. The primary endpoint was inhibition of duodenal peristalsis. Secondary endpoints included the required time from drug spraying to cessation of duodenal peristalsis, stop duration time (DT) from cessation of peristalsis until peristalsis recovery, and adverse events.

Eighteen patients from the lidocaine group and 19 patients from the control group were analyzed for the primary outcome. The inhibition rate of duodenal peristalsis was significantly higher in the lidocaine group (94.4%) than in the control group (52.6%) (p = 0.008). The required time was significantly shorter in the lidocaine group than in the control group (p < 0.001). No significant difference was observed in the stop DT (p = 0.862); no adverse events occurred in either group.

In our limited cohort, lidocaine inhibited duodenal peristalsis during ERCP without adverse events, suggesting its potential as a safe and practical option (jRCT No. 031190059).