Comparative study between magnesium sulphate and L-hyoscyamine on duodenal motility during ERCP under general anaesthesia: A prospective randomized study

Abstract

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) is a relatively complex procedure as compared with other endoscopy which needs longer duration, duodenal relaxation and good sedation. The aim of this study was to evaluate the efficacy and safety of magnesium sulphate as spasmolytic agent during ERCP under general anaesthesia. Design: A prospective randomized study. Setting: Delivery room, operating room and postoperative recovery area. Patients and method: Patients, who were treated for calcular obstructive jaundice by ERCP were randomized into two groups. The patients were randomized into two groups: G I, patients received 500 mg magnesium sulphate in 100 ml saline 15 min before induction and G II, patients received 0.5 mg L-hyoscyamine sulphate before induction of anaesthesia. Measurement: The primary outcome was duodenal relaxation during ERCP under general anaesthesia. Secondary outcomes include changes of heart rate, changes in oxygen saturation, time needed for cannulation, procedure difficulty, duration of the procedure, post-procedure complications, and the need of post-procedure analgesia. Results: Duodenal motility score was found to be 0.85 ± 1.47 in GI and 2.2 ± 3.08 in GII (P = 0.0001). The number of patients who had no duodenal contraction was significantly more in GI. The success rate of biliary cannulation is significantly higher in GI than in GII (58 (100%) vs 54 (93.1%), P = 0.04). The duration of cannulation was significantly shorter in GI. The number of patients who developed pancreatitis, nausea and vomiting was significantly less in GI. The pulse rate was found to be statistically less in GI at different time follow-ups. Conclusion: Magnesium sulphate is a safe spasmolytic agent during general anaesthesia that improves the success rate of ERCP and it allows easy completion of the procedure by decreasing the duodenal motility. It decreases the duration of the procedure, subsequently shortens the period of anaesthesia and improves post procedure recovery. It reduces post ERCP pancreatitis, nausea and vomiting.