Oral Administration of Edible Oil Prior to ERCP

Abstract

Purpose: Selective cannulation of the duct of intent is the first crucial step during ERCP. A prior report has shown that a liquid fatty meal prior to ERCP relaxes the sphincter of Oddi & facilitates biliary cannulation. Aim: To assess the effect of oral administration of oil prior to ERCP on deep biliary cannulation at a tertiary care ERCP center involving both trainees & expert faculty endoscopists. Methods: Patients undergoing ERCP for biliary etiology & arriving > 1 hr prior to the procedure were given 45 ml corn oil (42 gm fat; Crisco, Orrville, OH) by mouth. Patients not receiving oil served as controls. Only patients with a virgin papilla were included. Exclusion criteria: prior sphincterotomy, prior unsuccessful ERCP, indwelling stent, acute pancreatitis, altered anatomy, gastroparesis, or sphincter of Oddi manometry. Appearance of the papillary orifice, deep biliary cannulation time, fluoroscopy time, rate of successful cannulation, & complications were noted for both fellows & faculty endoscopists. Results: Oil was administered to 38 patients (mean age 52 yrs;50% male) while 42 pts served as controls (mean age 55 yrs;57% male). The papillary orifice was gaping or open in 26/38 (68%) & 22/41 (53%) patients in the oil & control groups respectively. Bile flow from the papilla was seen in 63% & 43% pts in the 2 groups. There was no difference in time to successful cannulation for fellows in each group (3.3 min, range 0.5–14.5 min; and 3.5 min, range 0.2–8.3 min respectively). Fluoro time for biliary cannulation for fellows was 0.9 min (0.1–2.1) & 1.3 min (0.3–5) in the two groups respectively. Fellows were successful in deep biliary cannulation in 22/35 (63%) & 23/38 (61%) respectively. Faculty endoscopists were successful in 15/15 (100%) and 13/14 (93%) respectively after fellows had failed. Faculty endoscopists were successful in all cases performed without fellows (3/3 and 4/4 in each group & precut sphincterotomy was not required). Overall cannulation success rate was 38/38 (100%) & 40/41 (98%) respectively, including precut sphincterotomy in 5/38 (6%) & 3/41 (7%) in the oil & control groups. Biliary cannulation was unsuccessful in 1/41 (2%) in the control group despite precut sphincterotomy. The procedure was aborted in 1 patient in the control group due to arrhythmia. There were no complications (including aspiration, pancreatitis) in either group. Conclusion: Papillary orifice was more open after oil, & bile flow was seen in more patients receiving oil than in controls. However, there was no difference in the success rate of biliary cannulation, cannulation time or fluoro time in the two groups. Further studies with larger numbers of patients may be necessary to demonstrate a beneficial effect, especially at major ERCP centers.