Background and study aims: Several studies have suggested that nitroglycerin promotes pancreatic drainage and
thereby helps to prevent pancreatitis occurring after endoscopic retrograde cholangiography
(ERC). We performed a multicenter, double-blind, randomized, placebo-controlled trial
to evaluate the efficacy of intravenous nitroglycerin for preventing acute pancreatitis
in moderate- to high-risk patients undergoing ERC.
Patients and methods: The patients underwent therapeutic ERC for gallstone removal, bile duct stenosis,
or sphincter of Oddi dysfunction (SOD). They were randomly allocated to receive an
intravenous nitroglycerin bolus of 0.1 mg, then 35 µg/kg per minute intravenously
(maximum dose 9 mg) for 6 h, or an identical placebo regimen. Serum amylase and lipase
levels were determined before and 24 h after ERC.
Results: The study was terminated after the interim analysis. The intention-to-treat population
consisted of 208 patients enrolled in 20 centers, of whom 105 received nitroglycerin
and 103 placebo therapy. Post-ERC pancreatitis (mild/moderate/severe) occurred in
25 patients, comprising 10 (3/5/2) in the nitroglycerin arm and 15 (5/6/4) in the
placebo arm (OR 0.62, 95 % CI 0.26 – 1.45; P = 0.26). Pancreatitis-related hospital stays were similar in the two groups (median
4 days, range 2 – 13 days in the nitroglycerin group; median 5 days, range 2 – 20
days in the placebo group). The incidence of pancreatitis in patients with SOD did
not differ between the groups (4/11 in the nitroglycerin arm, and 4/15 in the placebo
arm). Adverse events were more frequent in the nitroglycerin group and led to cessation
of drug infusion in 10 patients in the nitroglycerin arm and in 2 patients in the
placebo arm (P = 0.019).
Conclusion: In this study, nitroglycerin offered a limited and clinically nonsignificant benefit
for the prevention of post-ERC pancreatitis. Its use did not improve the technical
success rate of ERC.
References
m.beauchant@chu-poitiers.fr
