Meglumine Gadoterate: A New Safe Radiocontrast Medium for Endoscopic Retrograde Cholangiopancreatography?

Abstract

The radiocontrast substance meglumine gadoterate (MG) is used in magnetic resonance imaging. It is characterized by its low rate of adverse drug reactions. In an open study we tested whether MG is useful in endoscopic retrograde cholangiopancreatography. The patients received in sequence MG and ioxotalamate. MG, in contrast to ioxotalamate, failed to visualize the proximal pancreatic and peripheral intrahepatic ducts. Thus, MG is not useful in routine endoscopic retrograde cholangiopancreatography. However, in patients with a history of severe allergic reactions to conventional contrast media, MG may be recommended when pathological findings of the extrahepatic bile duct or the area of the pancreatic head are suspected.

Uso de gadolinio como contraste en CPRE en pacientes con reacciones adversas a contrastes yodados

“…Las diferencias en la calidad de imagen descrita en las distintas publicaciones probablemente esté relacionada con la diferente composición química de los compuestos usados, en el estudio de Dorta et al 12 el gadoterato de meglumina contiene 78,6 mg de gadolinio por mililitro de compuesto mientras que el gadobutrol contiene 157,25 mg/ml. La cantidad de contraste utilizada en el procedimiento es similar a la utilizada habitualmente con los contrastes yodados, y la diferencia en la viscosidad del compuesto 4,96 mPas respecto al que utilizamos habitualmente 3 mPas (Iohexol 300 mg/ml diluido 1:1) no supuso ninguna dificultad a la inyección a través de los catéteres.…”

KM-Allergie und ERCP: Prophylaxe notwendig?

“…His low incidence explains the lack of formal evidence based recommendations.The standard practice recommends prophylaxis, even if data including patients at risk suggest that the use of prophylactic regiments appears to be unnecessary. [14]. Sollte sich die Risikokonstellation erst kurz vor der Untersuchung herausstellen, so verabreichen die 74 % der Endoskopiker Prednison intravenös, die restlichen der befragten Endoskopiker verschieben zur Komplettierung der Prophylaxe die Untersuchung um einen Tag.…”

Successful Lithotripsy Under Fluoroscopy Without Cholangiography and Confirmation: Absence of Remnant Stones Using Gadolinium Chelate Combined With Intraductal Ultrasound in a Patient Anaphylactic to Iodine‐based Contrast Agent

“…Until now, in the English literature, 15 cases undergoing ERCP using gadolinium as contrast media have been reported, 1–4 including therapeutic ERCP 3,4 . In these reports, ERCP procedures were successfully carried out withoutadverse reaction.…”

“…Adequate visualization of extrahepatic and proximal intrahepatic bile ducts was achieved in 13/14 (93%) of the reported cases (Table 1). However, gadolinium may not be optimum for visualization of pancreatic duct structures 1 …”