A PROSPECTIVE, DOUBLE-BLIND TRIAL OF L-HYOSCYAMINE VERSUS GLUCAGON FOR THE INHIBITION OF SMALL-INTESTINAL MOTILITY DURING ERCP

Background: Glucagon is often used to inhibit duodenal motility and en hance cannulation during ERCP. Levsin is an antimuscarinic, anticholin ergic agent that may be as effective as glucagon. Methods: Three hundr ed eight patients requiring an antimotility agent during ERCP were ran domized in a double-blind prospective study to intravenous Levsin or g lucagon. Parameters recorded included difficulty of procedure, predrug and postdrug motility grade, effectiveness of medication, patients re quiring ''crossover'' drug, side effects, and cost per case. Results: One hundred fifty-three patients were randomized to glucagon and 155 t o Levsin. The two groups were equally matched with regard to patient a nd procedure characteristics. Of statistical significance were the fol lowing: (1) 12 patients in the Levsin group required crossover compare d to 1 patient in the glucagon group, (2) Levsin was slightly less eff ective in inhibiting motility, but this did not adversely influence pr ocedure difficulty, (3) Levsin was associated with more minor side eff ects (nausea, vomiting, and pain) at 2 hours after the procedure (Levs in 36 of 143, glucagon 24 of 152, p = 0.045) but there was no differen ce in pancreatitis (glucagon 6, Levsin 8), (4) Levsin was associated w ith a significant cost advantage (Levsin $10.45/case, glucagon $29.51/ case, p < 0.001). Conclusion: Levsin may provide a reasonable alternat ive antimotility agent during ERCP. Levsin does not appear to alter th e rate of significant postprocedure complications. The cost benefit ad vantage appears to be substantial.