Topical Application of Nitrates onto the Papilla of Vater: Manometric and Clinical Results

Abstract

Both topically administered GTN and ISDN evoked a profound inhibition of SO motility, but the effect of ISDN was longer lasting than that of GTN. However, locally administered GTN did not facilitate selective bile-duct access during routine ERCP.

Epinephrine sprayed on the papilla for prevention of post-ERCP pancreatitis

“…5 Systemic or sublingual administration of glyceryl trinitrate also relaxes the sphincter of Oddi. 6 Although neither drug when sprayed on the papilla decreases the incidence of post-ERCP pancreatitis, 5,6 there is a need to investigate other agents that effectively reduce the rate of this common and potentially severe complication.…”

Does topical GTN on the sphincter of Oddi facilitate ERCP? A double-blind randomized control trial

“…Ghori et al [9] administered sublingual GTN (400-800 lg) prior to ERCP and demonstrated an overall improvement in cannulation rate but not in the time to cannulation. Wehrmann et al [25] used topical GTN and were unable to demonstrate any advantageous effect on the number of cannulation attempts or time to successful cannulation. The rates of NKP in the two groups in their study were not statistically different.…”

“…The effects of GTN wane after 2-3 min [15,25]. As is often the case, the more difficult procedures are likely to involve anatomical variations, thus taking longer to perform.…”

“…Sublingual GTN has been shown to improve cannulation rate but not the time to cannulation [9]. Topical GTN has been shown to reduce manometric readings at the SO, but this did not facilitate bile duct cannulation [25]. It is the purpose of this prospective randomized control study to determine whether topical application onto the duodenal papilla of GTN aided cholangiography and bile duct cannulation at ERCP.…”

Advances in endoscopic retrograde cholangiopancreatography cannulation

“…However, another randomized controlled trial showed that intravenous administration of CCK during ERCP had no effect on cannulation [52] . Topical nitroglycerin was also shown to relax the sphincter of Oddi but there was no effect on rates of selective bile duct cannulation [53,54] .…”