The Effects of Sublingual Nitroglycerin (NTG) on the Sphincter of Oddi Manometry

Abstract

For the purpose of evaluating the effects of nitroglycerin (NTG) on the sphincter of Oddi (SO), 80 patients (69 males, 11 females) received SO manometry prior to and 3 minutes after sublingual administration of NTG (1.2mg). The indications for SO manometry were: suspected SO dysfunction in 28 patients, post-cholecystectomy syndrome in 25 patients, cholelithiasis or choledocholithiasis in 18 patients and idiopathic pancreatitis in 9 patients. The juxtapapillary diverticulum (JPD) was noted in 27 patients. SO dysfunction was found in 28 patients during routine manometry and in another 3 patients after pharmacological test with NTG. After NTG administration, four patients (5%) had an increase in SO basal pressure (SOBP) of more than 5 mmHg; the remaining 76 patients had a significant decrease in the ductal pressure (DP) from 11.6±18.1 mmHg to 8.3±9.8 mmHg p＜0.05), SOBP from 22.3±16.0 mmHg to 16.3±15.5 mmHg (p＜0.001), amplitude from 101.7±48.8 mmHg to 80.6±52.4 mmHg (p＜0.00l) and frequency of SO phasic contraction from 4.7±2.1/min. to 3.7±2.0/min. (p＜0.00l). No significant change in propagation of SO phasic contraction was detected after NTG. There was no significant difference in SO manometry in patients with and without JPD. Two patients developed a mild headache after NTG administration and one patient presented with symptomatic pancreatitis after SO manometry. All three patients recovered after conservative treatment. From our results, we conclude that sublingual NTG is a safe, economic and effective drug to relax the SO which can help the diagnosis of SO dysfunction.