Confirmation of the antispasmodic effect of shakuyaku-kanzo-to (TJ-68), a Chinese herbal medicine, on the duodenal wall by direct spraying during endoscopic retrograde cholangiopancreatography

Abstract

The purpose of the study was to evaluate the suppressive effect of TJ-68 on duodenal spasms during endoscopic retrograde cholangiopancreatography (ERCP). At the point when the duodenal papilla was confirmed after insertion of the endoscope during ERCP, 5.0 g TJ-68 (Tsumura Co., Tokyo, Japan) was dissolved in 50 ml of saline at 36 degrees C, and the whole volume was sprayed slowly using a spray tube from the orifice of the forceps to the duodenal papilla of the 50 patients who demonstrated peristalsis of the digestive tract ("duodenal spasm"). The endoscopic procedure was not performed during that time, and the time until the spasm was suppressed was determined. After the arrest of the spasm, the intended tests and treatment were conducted, and the time until the duodenal spasm started again was determined. The suppressive effect on duodenal spasm was observed in 38 (76%) of 50 patients. The duration from the spraying of TJ-68 of the patients who observed the suppressive effect on duodenal spasm was 50-182 s (mean 122 +/- 21 s). The spasm arrest duration was 7.2-21 min (mean 9.6 +/- 1.2 min). Direct spraying of TJ-68 on the duodenal mucosa suppressed duodenal spasm, and it may be useful during ERCP when anticholinergic agents are contraindicated.

Direct Spraying of Shakuyakukanzoto onto the Duodenal Papilla: A Novel Method for Preventing Pancreatitis following Endoscopic Retrograde Cholangiopancreatography

“…We previously reported at the Japan Digestive Disease Week 2006 that duodenal peristalsis was inhibited by directly spraying TJ-68 solution onto the duodenum during ERCP. Sakai et al [26] later confirmed this finding, reporting that TJ-68 inhibited duodenal spasm during ERCP. These effects were observed because TJ-68 in Glycyrrhizae radix inhibits acetylcholine-induced contraction of the smooth muscle and Paeoniae radix inhibits neurogenic contraction.…”

The influence of duodenally-delivered Shakuyakukanzoto (Shao Yao Gan Cao Tang) on duodenal peristalsis during endoscopic retrograde cholangiopancreatography: a randomised controlled trial

“…In a previous observational study [9], Shakuyakukanzoto acted as an anti-spasmodic agent and abolished duodenal peristalsis in the majority of participants to whom it was administered, but this was not a randomised, controlled study and the extent of suppression of peristalsis was not measured. In this study, we excluded participants in whom duodenal peristalsis was not evident at duodenoscopy, and assessed peristalsis and its influence on the technical difficulty of cannulating the common bile duct using the scoring system previously described by Niwa et al [11].…”

“…The sample size calculation for this study was based on the effective rate achieved in a previous trial, with the response rates in the Shakuyakukanzoto and control groups expected to be 70 and 10%, respectively. The no-peristalsis rate was expected to be 40% [9, 13]. The target sample size required to detect a difference in the response rate between the groups with a significance level of 5% and a power 90% was 13 per group, including a 40% dropout rate.…”

“…We have previously reported the inhibitory effect of Shakuyakukanzoto on duodenal peristalsis during ERCP [8], a finding that was later corroborated by Sakai et al [9]. This randomised clinical trial aimed to evaluate the inhibitory effect of Shakuyakukanzoto on duodenal peristalsis and its utility when administered directly into the duodenum just before ERCP.…”

A Valid Approach in Refractory Glossodynia: A Single-Institution 5-Year Experience Treating with Japanese Traditional Herbal (Kampo) Medicine

“…Shakuyakukanzoto, a Kampo prescription consisting of Glycyrrhiza Root and Peony Root, has been well-known among primary care doctors in Japan for having an immediate relieving effect on muscle cramps [5, 36], which has been proven by several open-labeled trials in hemodialysis patients [46, 47]. Shakuyakukanzoto also has a significant suppressive effect on duodenal spasms during endoscopic retrograde cholangiopancreatography [48]. Taken together, the combination of Glycyrrhiza Root and Peony Root seems to have an antispasmodic pain-relieving effect on both skeletal and smooth muscle.…”