SINCALIDE - A CHOLECYSTOKININ AGONIST AS AN AID IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY - A PROSPECTIVE ASSESSMENT

Although several approaches to overcome difficult bile duct cannulatio n and gain free biliary access have been popularized, the use of gastr ointestinal peptide hormonal agents such as sincalide, a cholecystokin in agonist, as an alternative method has not been evaluated. I have ca rried out a prospective, nonrandomized assessment of the use of sincal ide for diagnostic and therapeutic endoscopic retrograde cholangiopanc reatography (ERCP). Overall, sincalide was used in 23% (32/136) of ERC Ps in 26.6% (29/109) patients. Sincalide was successfully used to (a) obtain a cholangiogram after initial failure using only a standard cat heter in 12 of 19 patients; (b) precisely locate the papilla and bile duct orifice in five of five patients; (c) locale the bile duct openin g to obtain a cholangiogram and free cannulation during needle-knife p apillotomy or weeks later in five of seven and three of three patients , respectively; and (d) gain free access (deep cannulation) to the bil e duct after a cholangiogram in 5 of 10 patients. The selected use of sincalide appears to enhance the success of diagnostic and therapeutic ERCP; however, perseverance alone may account for some of this succes s. Controlled, randomized trials comparing sincalide or nothing, sinca lide or a sphincterotome, or sincalide or glide or guide wire in patie nts in whom initial attempts to obtain a cholangiogram are unsuccessfu l are warranted.