Jump to main content
US EPA
United States Environmental Protection Agency
Search
Search
Main menu
Environmental Topics
Laws & Regulations
About EPA
Health & Environmental Research Online (HERO)
Contact Us
Print
Feedback
Export to File
Search:
This record has one attached file:
Add More Files
Attach File(s):
Display Name for File*:
Save
Citation
Tags
HERO ID
2248890
Reference Type
Journal Article
Title
A prospective, randomized, placebo-controlled trial of transdermal glyceryl trinitrate in ERCP: effects on technical success and post-ERCP pancreatitis
Author(s)
Kaffes, AJ; Bourke, MJ; Ding, S; Alrubaie, A; Kwan, Vu; Williams, SJ
Year
2006
Is Peer Reviewed?
Yes
Journal
Gastrointestinal Endoscopy
ISSN:
0016-5107
Volume
64
Issue
3
Page Numbers
351-357
Language
English
PMID
16923481
DOI
10.1016/j.gie.2005.11.060
Web of Science Id
WOS:000240304200009
Abstract
BACKGROUND:
Despite the recent improvement in techniques and patient selection, post-ERCP pancreatitis remains the most frequent and dreaded complication of ERCP. Recent studies suggest that pretreatment with glyceryl trinitrate (GTN) may prevent post-ERCP pancreatitis and improve cannulation success.
OBJECTIVE:
To evaluate the effect of transdermal GTN on ERCP cannulation success and post-ERCP pancreatitis.
DESIGN:
Prospective, double-blind, placebo-controlled trial.
SETTING:
Tertiary referral university hospital.
PATIENTS:
A total of 318 patients (mean age 62 years, 61% women) were randomized to either active (n = 155) or placebo (n = 163) arms.
INTERVENTIONS:
Active patch (GTN) versus placebo patch.
MAIN OUTCOME MEASUREMENTS:
Cannulation time and success. Post-ERCP pancreatitis rates.
RESULTS:
There was no significant difference between the active or placebo arms for the following: successful initial cannulation (96.8% vs 98.8%), deep cannulation (96.1% vs 98.8%), time to successful cannulation, use of guidewire (27% vs 25%) or needle knife (13% vs 13%), and post-ERCP pancreatitis (7.4% of placebo patients and 7.7% active patients). Multivariate analysis identified women, younger patients, pancreatogram, number of attempts on papilla, and poor pancreatic-duct emptying after opacification as risk factors for post-ERCP pancreatitis. Transdermal GTN did not reduce post-ERCP pancreatitis in any of the identified high-risk groups.
CONCLUSIONS:
Transdermal GTN did not improve the rate of success in ERCP cannulation or prevent post-ERCP pancreatitis in either average or high-risk patient groups.
Home
Learn about HERO
Using HERO
Search HERO
Projects in HERO
Risk Assessment
Transparency & Integrity