Efficacy of peppermint oil as an antispasmodic during endoscopic retrograde cholangiopancreatography

J Gastroenterol Hepatol. 2006 Sep;21(9):1394-8. doi: 10.1111/j.1440-1746.2006.04307.x.


Background: During endoscopic retrograde cholangiopancreatography (ERCP), hyoscine-N-butylbromide (Buscopan) or glucagon is used to inhibit duodenal motility. However, they may cause adverse effects. Peppermint oil has an antispasmodic effect and is used as a less hazardous antispasmodic during colonoscopy and upper gastrointestinal endoscopy. The purpose of the present paper was therefore to investigate peppermint as an antispasmodic for ERCP.

Methods: Forty patients were enrolled prospectively. They were assigned to four groups according to the peppermint oil concentration and site of administration: group 1, 20 mL of 1.6% solution around duodenal papilla; group 2, 20 mL of 1.6% solution both to the antrum of the stomach and around the duodenal papilla; group 3, 20 mL of 3.2% solution around the duodenal papilla; and group 4, 3.2% solution both to the antrum and around the duodenal papilla. Glucagon or hyoscine-N-butylbromide was added when duodenal peristalsis was not adequately diminished. Sixteen patients undergoing ERCP with glucagon were employed as historical controls.

Results: The ERCP was attempted in all except one patient in group 2 who had bleeding from invaded tumor to the duodenum. Peppermint administration equally reduced duodenal motility in the groups. Duodenal movement was none or mild in 69.2% of patients. The ERCP was successfully performed with peppermint alone in 91.4% of patients (37/39). Glucagon or hyoscine-N-butylbromide was needed in one patient each in groups 1 and 4. Serious complications related to peppermint oil did not occur. Inhibitory effect of peppermint appears to be identical to that of glucagon.

Conclusion: Duodenal relaxation was obtained with 20 mL of 1.6% peppermint oil solution in the duodenum, but additional administration may be required. Peppermint oil is useful as an antispasmodic agent for ERCP.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Butylscopolammonium Bromide / adverse effects
  • Butylscopolammonium Bromide / therapeutic use
  • Cholangiopancreatography, Endoscopic Retrograde*
  • Duodenum / drug effects
  • Duodenum / metabolism
  • Female
  • Gastrointestinal Motility / drug effects
  • Glucagon / therapeutic use
  • Humans
  • Male
  • Mentha piperita
  • Middle Aged
  • Muscarinic Antagonists / adverse effects
  • Muscarinic Antagonists / therapeutic use
  • Parasympatholytics / administration & dosage
  • Parasympatholytics / adverse effects
  • Parasympatholytics / pharmacology
  • Parasympatholytics / therapeutic use*
  • Plant Oils / administration & dosage
  • Plant Oils / pharmacology
  • Plant Oils / therapeutic use*
  • Prospective Studies
  • Retrospective Studies
  • Spasm / drug therapy*


  • Muscarinic Antagonists
  • Parasympatholytics
  • Plant Oils
  • Butylscopolammonium Bromide
  • Glucagon
  • peppermint oil