Document Detail


Topical application of nitrates onto the papilla of Vater: manometric and clinical results.
MedLine Citation:
PMID:  11315893     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND STUDY AIMS: Systemic administration of nitrates inhibits motility of the sphincter of Oddi (SO) but is hampered by a decrease of the arterial blood pressure. We evaluate whether topical application of glyceril trinitrate (GTN) onto the papilla can facilitate cannulation of the common bile duct during routine endoscopic retrograde cholangiopancreatography (ERCP) and compare the effect of topical GTN with that of isosorbide dinitrate (ISDN) on SO motility. PATIENTS AND METHODS: A total of 80 patients undergoing routine ERCP for suspected biliary obstruction received topical application of either saline (n = 40) or 10 mg of GTN (n = 40) onto the papilla of Vater in a randomized, double-blind fashion. Thereafter, selective bile-duct cannulation was attempted with a 0.035" hydrophilic guide wire. In another trial, 16 biliary type III patients underwent endoscopic SO-manometry and received in a randomized fashion either 10 mg of GTN (n = 8) or 10 mg of ISDN (n = 8) which was infused topically onto the papilla via the manometric catheter. Thereafter, the manometric recording was continued for a further 5 minutes. RESULTS: A spontaneous opening of the papilla with concurrent transpapillary bile flow was observed in 24/40 patients after topical GTN, and in only 8/40 patients after topical saline (P < 0.01). However, neither the number of cannulation attempts nor the time until successful cannulation differed significantly between the groups. In addition, the pre-cut rate was nearly identical in the two groups. Topical GTN showed no significant influence on the mean arterial blood pressure. The SO-baseline pressure was significantly lowered by topical GTN (28.2+/-12.9 mm Hg before ISDN vs. 22.5+/-13.7 mmHg after P<0.01). The phasic SO motility was also strongly inhibited by both drugs. However, the effect of GTN completely wanes after 3 minutes, whereas ISDN inhibited SO motility for > 5 minutes in all patients. CONCLUSIONS: 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.
Authors:
T Wehrmann; T Schmitt; N Stergiou; W F Caspary; H Seifert
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Endoscopy     Volume:  33     ISSN:  0013-726X     ISO Abbreviation:  Endoscopy     Publication Date:  2001 Apr 
Date Detail:
Created Date:  2001-04-23     Completed Date:  2001-08-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0215166     Medline TA:  Endoscopy     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  323-8     Citation Subset:  IM    
Affiliation:
Dept. of Internal Medicine I, Academic Hospital Hannover-Siloah, Germany. twehrmann@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Administration, Topical
Adolescent
Adult
Ampulla of Vater / drug effects*,  physiology
Catheterization / methods*
Cholangiopancreatography, Endoscopic Retrograde / methods*
Cholestasis / diagnosis,  radiography*
Double-Blind Method
Female
Humans
Isosorbide Dinitrate / administration & dosage*
Male
Manometry
Middle Aged
Nitroglycerin / administration & dosage*
Peristalsis / drug effects
Probability
Reference Values
Sensitivity and Specificity
Statistics, Nonparametric
Vasodilator Agents / administration & dosage*
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 55-63-0/Nitroglycerin; 87-33-2/Isosorbide Dinitrate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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