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

Abstract

Background/Aims: Topical epinephrine application to the duodenal papilla reduces spasm of the sphincter of Oddi and prevents acute pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). Shakuyakukanzoto (TJ-68) has an inhibitory effect on muscle contraction. Therefore, TJ-68 potentially allows the relaxation of the sphincter of Oddi, which can aid in the prevention of post-ERCP pancreatitis. Methods: Thirty-six patients planned for ERCP were divided into TJ-68 (n = 17) and control groups (n = 19). In the TJ-68 group, the TJ-68 solution was endoscopically sprayed directly onto the duodenal papilla of patients. To assess the effects of TJ-68, serum amylase levels were measured at 1 h and 1 day after ERCP and symptoms were evaluated. Results: The serum amylase levels at 1 h after ERCP were 273.6 ± 212.0 IU/l in the TJ-68 group and 428.7 ± 281.6 IU/l in the control group, showing a statistically significant difference (p = 0.036). The serum amylase levels at 24 h after ERCP were 230.0 ± 182.7 IU/l in the TJ-68 group and 497.4 ± 514.0 IU/l in the control group (p = 0.011). Post-ERCP pancreatitis was observed in 0 and 4 patients (21.1%) in the TJ-68 and control groups, respectively, which was not statistically significant (p = 0.11). Conclusion: Direct TJ-68 solution application to the duodenal papilla significantly inhibited the elevation of serum amylase levels. However, the preventive effect regarding post-ERCP pancreatitis was not confirmed in this study.

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

“…In this study, we evaluated the efficacy of Shakuyakukanzoto administered directly into the duodenum immediately before ERCP. We have also found that Shakuyakukanzoto sprayed directly onto the duodenal papilla significantly reduced serum amylase concentration 1 h and 1 day after ERCP [40]. Although we assessed only ERCP, our findings might also apply to other endoscopic examinations, such as upper endoscopy, balloon endoscopy and colonoscopy.…”

Effect of Shakuyaku‐kanzo‐to in patients with muscle cramps: A systematic literature review

“…SKT has been found to show immediate efficacy against painful muscle cramps induced by liver cirrhosis, hemodialysis, and diabetic neuropathy . SKT has been reported to inhibit acetylcholine‐induced and neurogenic contractions of the gastrointestinal tract and to decrease unfavorable smooth muscle contractions during upper and lower gastrointestinal endoscopy . SKT also inhibits oxytocin‐induced myometrial contractions of uterine tissue in pregnant women in a dose‐dependent manner .…”

Incidence of adverse event associated with endoscopic retrograde cholangiopancreatography in the current era: Pursuit of a lower incidence of postendoscopic retrograde cholangiopancreatography pancreatitis

“…The same can also be applied to other preventive factors. Various drugs have been attempted to be sprayed onto the papilla including epinephrine until now 9,10 . However, their effects have not been proven yet.…”