Comparative study of fatty meal Versus drotaverine hydrochloride Versus hyoscine-n-butylbromide for duodenal antimotility and ease of cannulation during Endoscopic Retrograde Cholangiopancreatography (ERCP).

Vadivel Kumaran, S (2014) Comparative study of fatty meal Versus drotaverine hydrochloride Versus hyoscine-n-butylbromide for duodenal antimotility and ease of cannulation during Endoscopic Retrograde Cholangiopancreatography (ERCP). Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Endoscopic retrograde cholangiopancreatography (ERCP) is in clinical practice since 1968 for diagnosis and treatment of pancreatobiliary diseases. ERCP is a technically demanding procedure that requires considerable amount of training to be performed safely. Common bile duct (CBD) and/or the pancreatic duct (PD) cannulation is the critical step. Failed intervention or an aborted procedure is due to failure of cannulation of the desired ducts. A side viewing duodenoscope of 120cms is necessary for cannulation of normal gastrointestinal anatomy, whereas a forward viewing duodenoscope may be necessary in case of altered anatomy like Billroth II anastomoses, Roux‐en Y anastomosis, Choledochojejunostomy and Hepaticojejunostomy. In surgically altered anatomy, usage of a double or “short” double‐balloon and single balloon enteroscopy has achieved a higher successful cannulation rates. For diagnostic and therapeutic interventions like sphincterotomy, stent placement and stone extraction, cannulation of the ampulla of Vater and wire access of the ampulla is the prime requirement. A higher rate of successful cannulation without complications usually depends on the expertise of the endoscopist. Those with lesser experience have a much lower rate of success and higher occurrence of complications. The anatomy typically predisposes to pancreatic duct cannulation as the pancreatic duct enters the ampulla in a straight fashion. Edema or strictures in the small bowel, surgically altered anatomy, blood or excessive fluid in the lumen and periampullary diverticulum increases the difficulty of the procedure. Prolonged cannulation often results in increased patient morbidity, unnecessary radiation exposure and anxiety for endoscopists. With normal anatomy, various technical methods have been adopted to facilitate cannulation at ERCP based on technical and pharmacological aspects. AIM : To compare the effect of Fatty meal versus Drotaverine hydrochloride versus Hyoscine‐N‐butyl bromide: On duodenal contraction rate, To identify the ampulla, Time for cannulation, Adverse events. CONCLUSION : In the current study fatty meal is not inferior to the conventionally used Hyoscine‐N‐butyl bromide or its alternate Drotaverine for its anti‐motility effect on the duodenum during ERCP. The cannulation time is no different within the groups. The identification of ampulla was easier with the fatty meal group. There is a possibility of higher increase in pulse rate and blood pressure in patients with ischemic heart disease with the use of Hyoscine‐N‐butyl bromide. Further larger randomized trials are required to confirm the efficacy of fatty meal in ERCP.

Item Type: Thesis (Masters)
Uncontrolled Keywords: fatty meal ; drotaverine hydrochloride ; hyoscine-n-butylbromide ; duodenal antimotility ; ease of cannulation ; Endoscopic Retrograde Cholangiopancreatography ; ERCP ; Comparative study.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:14
Last Modified: 13 Jul 2017 04:14
URI: http://repository-tnmgrmu.ac.in/id/eprint/1572

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