3344 Transdermal glyceryl trinitrate in the prevention of post-ercp pancreatitis.

Background/aim.- Spasm of sphincter of Oddi has been accepted as contributing factor in the development of post-endoscopic cholangiopancreatography acute pancreatitis (ERCP-AP). Glyceryl trinitrate (GTN) lowers the Oddi's sphincter pressure. A 54 mg GTN patch delivers 15 mg of GTN in a sustained way (24 hours). TransdermaL GTN could be effective in the prevention of ERCP-AP. Patients and Methods.- Patients undergoing ERCP were randomized to receive a patch with GTN 15mg or placebo 20-40 minutes prior to the procedure. We recorded the difficulty to cannulate, the need to use a wire guide or other auxiliary maneuvers, the number of selective pancreatic duct cannulations, and the amount of contrast solution. Amylase and lipase were determined at 0, 2 and 24 hours. The diagnosis of ERCP-AP was based on symptoms and 4-fold increase of serum amylase and/or amilase. Statistics was made by Student's t , Fisher s exact and χ 2 tests and logistic regression. Results.- Of 132 patients entered, 67 received GTN and 65 placebo. Both groups were similar with respect to: endoscopic therapies, injected contrast, solution volume and cannulation procedures. Baseline enzymatic values and the 2-hour/baseline amylase and lipase ratios were similar in both groups. However, the 24-hour/baseline amylase and lipase ratios were lower in the GTN group (3.5 vs. 7.5, p 10 was independently related with the number of pancreatic cannulations and GTN treatment. Conclusion: The use of transdermal patch of GTN seems to protect against post-ERCP-AP.