Oral administration of edible oil before ERCP: Effect on selective biliary cannulation

Background: A fatty meal before ERCP relaxes the sphincter of Oddi and may facilitate biliary cannulation. Objective: To assess the effect of an oral fatty meal before ERCP on time to and success rate of biliary cannulation. Design: Human clinical study. Setting: Tertiary ERCP center. Patients: Adult patients with intact papilla undergoing ERCP for presumed biliary pathology. Interventions: Patients arriving more than 1 hour before the procedure were given oil by mouth. Patients not receiving oil served as controls. The need for a precut sphincterotomy was considered a failure of initial cannulation. Main Outcome Measurements: Appearance of the papillary orifice, bile flow, cannulation success rate, cannulation and fluoroscopy times. Results: A total of 86 patients received oil (mean age 52.8 years; 40% male), and 103 patients served as controls (mean age 53.3 years; 49% male). The papillary orifice was open in 52 of 86 (61%) and 38 of 103 (37%) patients in the oil and control groups, respectively (P =.002). Bile flow was seen in 59 of 86 (68%) and 50 of 103 (49%) patients, respectively (P =.009). The overall initial biliary cannulation success rate was 80 of 86 (93%) and 97 of 103 (94%), respectively (P =.77). There was no difference in cannulation success rates, cannulation, and fluoroscopy times for fellows or faculty endoscopists in each group. No pulmonary aspiration was seen in either group. Limitations: Unblinded study. Conclusions: The biliary orifice appeared more open and bile flow was seen in more patients receiving oil, but there was no difference in successful biliary cannulation rates and cannulation and fluoroscopy times in the 2 groups.