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Original article Clinical endoscopy| Volume 77, ISSUE 1, P55-61, January 2013

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Oral administration of edible oil before ERCP: effect on selective biliary cannulation

      Background

      A fatty meal before ERCP relaxes the sphincter of Oddi and may facilitate biliary cannulation.

      Objective

      To assess the effect of an oral fatty meal before ERCP on time to and success rate of biliary cannulation.

      Design

      Human clinical study.

      Setting

      Tertiary ERCP center.

      Patients

      Adult patients with intact papilla undergoing ERCP for presumed biliary pathology.

      Interventions

      Patients arriving more than 1 hour before the procedure were given oil by mouth. Patients not receiving oil served as controls. The need for a precut sphincterotomy was considered a failure of initial cannulation.

      Main Outcome Measurements

      Appearance of the papillary orifice, bile flow, cannulation success rate, cannulation and fluoroscopy times.

      Results

      A total of 86 patients received oil (mean age 52.8 years; 40% male), and 103 patients served as controls (mean age 53.3 years; 49% male). The papillary orifice was open in 52 of 86 (61%) and 38 of 103 (37%) patients in the oil and control groups, respectively (P = .002). Bile flow was seen in 59 of 86 (68%) and 50 of 103 (49%) patients, respectively (P = .009). The overall initial biliary cannulation success rate was 80 of 86 (93%) and 97 of 103 (94%), respectively (P = .77). There was no difference in cannulation success rates, cannulation, and fluoroscopy times for fellows or faculty endoscopists in each group. No pulmonary aspiration was seen in either group.

      Limitations

      Unblinded study.

      Conclusions

      The biliary orifice appeared more open and bile flow was seen in more patients receiving oil, but there was no difference in successful biliary cannulation rates and cannulation and fluoroscopy times in the 2 groups.

      Abbreviations:

      CCK (cholecystokinin), SO (sphincter of Oddi)
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      References

        • Freeman M.L.
        • DiSario J.A.
        • Nelson D.B.
        • et al.
        Risk factors for post-ERCP pancreatitis: a prospective, multicenter study.
        Gastrointest Endosc. 2001; 54: 425-434
        • Badalov N.
        • Tenner S.
        • Baillie J.
        The prevention, recognition and treatment of post-ERCP pancreatitis.
        JOP. 2009; 10: 88-97
        • Freeman M.L.
        • Guda N.M.
        ERCP cannulation: a review of reported techniques.
        Gastrointest Endosc. 2005; 61: 112-125
        • Abdel Aziz A.M.
        • Lehman G.A.
        Pancreatitis after endoscopic retrograde cholangio-pancreatography.
        World J Gastroenterol. 2007; 13: 2655-2668
        • Barrie M.
        • Klein S.D.
        • Brown C.A.
        • et al.
        Endoscopic retrograde cholangiopancreatography after a liquid fatty meal: effect on deep common bile duct cannulation time.
        Endoscopy. 2006; 38: 241-248
        • Cotton P.B.
        • Eisen G.M.
        • Aabakken L.
        • et al.
        A lexicon for endoscopic adverse events: report of an ASGE workshop.
        Gastrointest Endosc. 2010; 71: 446-454
        • Freeman M.L.
        Adverse outcomes of ERCP.
        Gastrointest Endosc. 2002; 56: S273-S282
        • Silviera M.L.
        • Seamon M.J.
        • Porshinsky B.
        • et al.
        Complications related to endoscopic retrograde cholangiopancreatography: a comprehensive clinical review.
        J Gastrointest Liver Dis. 2009; 18: 73-82
        • Kalloo A.N.
        • Pasricha P.J.
        Effect of gastric distension and duodenal fat infusion on biliary sphincter of Oddi motility in healthy volunteers.
        Dig Dis Sci. 1995; 40: 745-748
        • Worthley C.S.
        • Baker R.A.
        • Iannos J.
        • et al.
        Human fasting and postprandial sphincter of Oddi motility.
        Br J Surg. 1989; 7: 709-714
        • Yamamura T.
        • Takahashi T.
        • Kusunoki M.
        • et al.
        Gallbladder dynamics and plasma cholecystokinin responses after meals, oral water, or sham feeding in healthy subjects.
        Am J Med Sci. 1988; 2: 102-107
        • Mossner J.
        • Grumann M.
        • Zeeh J.
        • et al.
        Influence of various nutrients and their mode of application on plasma cholecystokinin (CCK) bioactivity.
        Clin Invest. 1992; 2: 125-129
        • Summers R.W.
        • Johlin F.C.
        The pathophysiology, evaluation and management of motility disorders of the biliary tract.
        Gastroenterol Clin North Am. 1989; 2: 425-435