Effects of meperidine on the pancreatic and biliary sphincter.

Background: Opioids are traditionally avoided during sphincter of Oddi manometry because of indirect evidence suggesting that these agents cause sphincter of Oddi spasm. This study was undertaken to determine the direct effects of meperidine on the biliary and pancreatic sphincter.

Methods: Forty-seven patients were prospectively evaluated by sphincter of Oddi manometry in the conventional retrograde fashion.

Post-ERCP pancreatitis: randomized, prospective study comparing a low- and high-osmolality contrast agent.

Diagnostic and therapeutic ERCPs are complicated by pancreatitis in 1% to 10% of patients, and evidence suggests that the contrast agent used for ERCP may be important in the pathogenesis of such pancreatitis. This prospective, double-blind study was undertaken to determine whether the use of a low-osmolality, nonionic contrast agent (Omnipaque 300; iohexol, 672 mOsm/kg H2O) would reduce the frequency and severity of postprocedure pancreatitis as compared to a high-osmolality, ionic contrast agent (Hypaque 50%; diatrizoate sodium, 1515 mOsm/kg H20). Six hundred ninety patients undergoing diagnostic ERCP (pancreatogram, cholangiogram, or both) either with or without sphincter of Oddi manometry and therapy were randomized to iohexol or diatrizoate sodium.

Combined endosonography and fine-needle aspiration cytology in the evaluation of gastrointestinal lesions.

Fifty consecutive patients with extrinsic or submucosal masses, gastric ulcers, or surgical anastomoses suspected of malignancy but with previously negative findings on conventional forceps biopsy or brush cytology underwent endoscopic ultrasonography followed by fine-needle aspiration cytology. Diagnostic cytology results were obtained in 37 of 50 (74%) patients. In 11 of the 13 patients with negative fine-needle aspirates, the endosonographic findings supported the final diagnosis as assessed by clinical follow-up or surgical pathology findings.