The effect of lidocaine sprayed on the major duodenal papilla on the frequency of post-ERCP pancreatitis

Acute pancreatitis remains a serious cause of ERCP-related morbidity. Topical application of lidocaine reportedly blunts cholecystokinin release from intestinal mucosa and reduces sphincter of Oddi spasm. A randomized trial was conducted to evaluate the effect of lidocaine sprayed on the major duodenal papilla on the frequency of post-ERCP pancreatitis. Secondary outcomes evaluated were ease of cannulation and severity of post-ERCP pancreatitis. Patients undergoing ERCP were randomized in blocks of 6 to have 10 mL of either 1% lidocaine or normal saline solution sprayed on the major papilla before cannulation. Patients were observed for the development of post-ERCP pancreatitis. Patient history- and procedure-related variables were recorded. A total of 326 patients were enrolled, of whom 32 were excluded after randomization but before analysis. Of patients analyzed, 145 were randomized to treatment with lidocaine and 149 to placebo. No patient was lost to follow-up. There was no significant difference noted in patient history- or procedure-related variables. Seven patients in the lidocaine group and 5 in the placebo group developed post-ERCP pancreatitis ( p = 0.73). Ease of cannulation did not differ between the two groups. Lidocaine sprayed on the major papilla does not decrease the frequency of post-ERCP pancreatitis.