Diagnostic quality in endoscopic retrograde cholangiopancreatography : Comparison between iodixanol and iopromide

Background and Study Aims: The contrast medium for endoscopic retrograde cholangiopancreatography (ERCP) must produce adequate images, whilst keeping the risk of complications to a minimum. There is a theoretical reason to suppose that a dimeric isosmolar medium may be superior to a monomeric hyperosmolar medium. We have compared two such media in a triple-centre double-blind randomized study on patients referred with a clinical indication for ERCP. Patients and Methods: A total of 160 patients were randomly allocated to either Iodixanol or Iopromide. Assessments were made of the quality of images and the complications encountered. Results: A total of 151 patients were evaluated. Apart from a trend towards better diagnostic quality for main pancreatic duct imaging with Iodixanol, there were no differences between the two groups. The overall frequencies of adverse events were similar. Conclusions: Iodixanol is a safe and effective water-soluble contrast medium for ERCP, comparable to Iopromide, but despite theoretical advantages Iodixanol has no clear practical benefit.