Neostigmine (R) Improves Pancreatic Duct Visualization in Magnetic Resonance Cholangiopancreatography and Could Be a Cheap Alternative for Secretin

Background: To determine the effect of intramuscular administration of Neostigmine (R) on the visualization of the pancreatic duct on magnetic resonance cholangiopancreatography in patients with recurrent acute pancreatitis or abdominal pain. Methods: We reviewed patients undergoing magnetic resonance cholangiopancreatography followed by a Neostigmine (R)-enhanced magnetic resonance cholangiopancreatography. Patients with a history of recurrent acute pancreatitis or abdominal pain who had a magnetic resonance cholangiopancreatography where the pancreatic duct was not entirely seen, were selected to undergo a second magnetic resonance cholangiopancreatography 40 minutes after 0.5 mg Neostigmine (R). Images were analyzed by 2 radiologists. The diameter of the pancreatic duct was measured in the head, body, and tail of the pancreas on the baseline images and after Neostigmine (R). Results: Ten patients were included, with a median age of 33 years (range 15-61). The maximum diameter of the pancreatic duct increased significantly after Neostigmine (R) administration in all patients, from 1.84 +/- 0.98 to 3.41 +/- 1.27 mm in the head, 1.34 +/- 0.42 mm to 2.5 +/- 0.49 mm in the body and 0.72 +/- 0.52 mm to 1.78 +/- 0.43 mm in the tail (mean +/- SD, P <.0001). Neostigmine (R) helped to provide better detail of the pancreatic duct anatomy in 4 patients. In 2 patients we confirmed pancreas divisum, in another the Santorini duct was not seen on the baseline images but it was clearly visualized after Neostigmine (R), and in the fourth patient, Neostigmine (R) improved visualization of multiple pancreatic duct stenosis. Conclusion: Neostigmine (R)-magnetic resonance cholangiopancreatography significantly increases the diameter of the pancreatic duct, allowing an accurate morphological evaluation. It could be a cheap alternative to secretin, which is expensive and hardly available.