PERORAL TRANSPAPILLARY PANCREATOSCOPY UNDER THE ADMINISTRATION OF SUB-LINGUAL NITROGLYCERIN

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  • ニトログリセリン舌下投与による経口的膵管内視鏡検査

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Abstract

We performed peroral transpapillary pancreatoscopy for 33 patients who were suspected pancreatic cancer after medical sphincter dilation using sub-lingual nitroglycerin. By administration of 0.3-0.6 mg nitroglycerin pancreatoscope which has an outer diameter of 2.2 mm, could be easily inserted into a normal papilla of Vater in 29 of 33 patients (87.9%). Four patients could not keep the guide wire into the distal portion of pancreas because of obstruction of main pancreatic duct due to the cancer of head of the pancreas. The success rate of total pancreatoscopy or observation of obstructive lesion after the insertion was 79.3%. For general influence of nitroglycerin we analyzed changes of systolic blood pressure during peroral pancreatoscopic examination. Systolic blood pressure during examination was significantly decreased in the case with and without treatment of nitroglycerin. (p < 0.0001) No difference of decrease of systolic blood pressure between nitroglycerin and control group was existed. (p = 0.7127) In our study, this examination with sub-lingual administration of nitroglycerin is extremely effective for peroral transpapillary pancreatoscopy in patients with an intact papilla without any side effects.

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