Abstract

Vasoactive Intestinal Polypeptide (VIP) is 28 amino acid polypeptide hormone found throughout the enteric nervous system. VIP is a powerful gastrointestinal and vascular smooth muscle relaxant. In addition, VIP has a short duration of action because it is rapidly metabolized by tissue proteases. Because of the potent relaxant effects and short half-life, VIP may be useful as an inhibitor of gastrointestinal motility during endoscopy and ERCP. To determine the action of VIP on endoscopic duodenal motility, VIP was administered intravenously to patients undergoing endoscopy and manometry and video-motility of the duodenum were measured. Volunteers underwent routine upper endoscopy with a forward viewing endoscope and a pressure-transducing catheter was placed in the duodenum. VIP doses of 0.2-0.5 μg/kg were administered as two separate infusions and duodenal motility measured by continuous manometric recording and simultaneous time-stamped video-recording. Blood pressure, pulse, duodenal manometry and video-recordings were obtained for at least four minutes prior to, during and after each infusion. The second infusion of VIP was performed only if vital signs and motility returned to baseline. In five volunteers with active duodenal motility VIP significantly decreased contraction frequency from 5.5 to 1.9 contractions/min as measured by manometry and from 3.7 to 1.3 contractions/min as measured by video-motility. The VIP-stimulated decrease in contraction frequency was dose-dependent and lasted for a minimum of seven minutes. To assess the effect of VIP on the intensity of contractions VIP-stimulated incomplete contractions and intraduodenal pressure were analyzed. VIP infusion increased partial occlusion of the duodenal lumen as measured by videomotility 0.9 to 2.0 partial contractions/min and decreased the height of manometric contractions. VIP infusion increased heart rate and decreased both systolic and diastolic blood pressure in a dose-dependent manner. The VIP effect on vital signs was transient and judged to be not clinically significant. This study demonstrates that VIP is a potent inhibitor of duodenal motility. VIP significantly decreases duodenal motility by decreasing the frequency and intensity of contractions during endoscopy. The VIPstimulated effect on duodenal motility can be quantified using both manometric and video-recording techniques. In conclusion, VIP infusion may be useful in ERCP for cases where there is active duodenal motility.

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