BACKGROUND: We routinely used BS to dilute ERCP contrast media in hopes of limiting bacterial contamination. BS contains the bacteriostatic agent benzyl alcohol (0.9%). We observed that BS alone, when placed in the conjunctiva as eye drops, caused marked erythema and pain. We were then concerned that BS may be contributing to post-ERCP pancreatitis. METHODS: From 8/95-12/96,1735 patients were randomized to BS or NBS in the contrast media on alternating days. The contrast media used was 50% Hypaque sodium (Diatrizoate sodium, Nycomed Inc.) forpancreatography (containing no benzyl alcohol) and 25% (via dilution with NBS or BS) for biliary studies. BS potentially irritated the pancreas when biliary contrast media entered the pancreas during attempts at cholangiography A diagnosis of post-ERCP pancreatitis was made based on the Cotton criteria (Gastrointest Endosc 1991;37:383). Influence of procedure type (diagnostic, therapeutic, sphincter of Oddi manometry) was also assessed. RESULTS: 135/1735 patients (7.8%) developed post-ERCP pancreatitis. PANCREATITIS FREQUENCY AND SEVERITY Mild Moderate Severe Total Bacteriostatic Saline 54(6.4%) 10(1.2%) 3(0.4%) 67/838(8.0%) Non-bacteriostatic Saline 53(5.9%) 12(1.3%) 3(0.3%) 68/897(7.6%) There were no differences in pancreatitis frequency between BS and NBS as a whole or among the various diagnostic and therapeutic categories. CONCLUSION: Bacteriostatic saline does not appear to contribute to post-ERCP pancreatitis.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging