The Effectiveness and Strategy of Glucagon for the Pre-Treatment of Ercp-Related Procedures

Introduction: During endoscopic retrograde cholangiopancreatography (ERCP) and related procedures there is a need to suppress the excessive gastrointestinal peristalsis. Glucagon is known to suppress gastrointestinal peristalsis through exerting a direct action on the smooth muscle. The present study was undertaken to evaluate the usefulness of glucagon and to explore an efficient glucagon dosing method for pretreatment of ERCP. Methods: Between June 2012 to February 2013, 150 patients underwent ERCP or related procedures. These patients were divided at random into the following three groups for comparison of the success rate of cannulation without the need for an additional glucagon dose(s), percentage of patients requiring an additional glucagon dose(s) before completion of the procedure and the incidence of accidental complications: Group A (glucagon 1 mg dissolved in 100 mL of physiological saline, administered at an initial dosing rate of 200 mL/hr), Group B (intravenous injection of glucagon 1 mg at the time of the scope insertion), and Group C (no pretreatment). If duodenal peristalsis was seen twice or more often within a 5-second period, a judgment of “insufficient suppression of peristalsis” was made and glucagon 1 mg was additionally injected intravenously. Results: There were no significant differences in the background characteristics among the three groups. Bile duct cannulation was successful in all the patients, without any significant inter-group difference in the time until cannulation. However, the cannulation success rate without the need for an additional glucagon dose(s) was significantly higher in the glucagon dosing groups (98% in Group A, 92% in Group B and 38% in Group C). The total time taken for the examination did not differ significantly between any two of the three groups, but the percentage of patients receiving an additional glucagon dose(s) before completion of the procedure was significantly lower in Group A (12%) than in Group B (38%) and Group C (74%). No evident accidental complications were seen in any of the groups. Conclusion: Glucagon was useful as a mean of pretreatment for patients undergoing ERCP or related procedures. Its action lasted longer when it was administered by drip infusion, allowing the dose level to be reduced. Drip infusion of glucagon have high efficacy and a favorable cost-benefit ratio.