Elsevier

Gastrointestinal Endoscopy

Volume 80, Issue 6, December 2014, Pages 1103-1112.e2
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
The impact of hyoscine-N-butylbromide on adenoma detection during colonoscopy: meta-analysis of randomized, controlled studies

https://doi.org/10.1016/j.gie.2014.05.319Get rights and content

Background

Hyoscine-N-butylbromide (HBB) can induce flattening of colon folds through inhibition of smooth muscle activity, which improves mucosal visualization. Whether this affects polyp detection is controversial.

Objective

To evaluate whether HBB, administered during colonoscopy, improves polyp and adenoma detection.

Design

We performed a comprehensive search in MEDLINE and EMBASE databases to identify randomized, placebo-controlled trials (RCTs) in which HBB was administered during colonoscopy and which also reported the detection rate for polyps and/or adenomas (PDR and/or ADR, respectively).

Setting

Meta-analysis of 5 RCTs.

Patients

A total of 1998 patients (1006 receiving HBB) were included in the study.

Interventions

Intravenous administration of 20 mg (2 mL) HBB or 2 mL saline solution at the time of cecal intubation.

Main Outcome Measurements

The PDR was the primary outcome variable. Secondary outcomes included the ADR, the advanced adenoma detection rate (adv-ADR), and the mean number of polyps and adenomas per patient (PPP and APP, respectively).

Results

The PDR, ADR, and adv-ADR did not differ significantly between the 2 groups. The odds ratios (95% confidence interval [CI]) for PDR, ADR, and adv-ADR were 1.09, 95% CI, 0.91-1.31; 1.13, 95% CI, 0.92-1.38; and 0.9, 95% CI, 0.63-1.30, respectively. In addition, no significant differences were observed in PPP and APP between the 2 groups.

Limitations

Small number of studies included. Limited data about secondary outcomes and safety.

Conclusion

Our meta-analysis does not provide evidence that routine HBB administration at cecal intubation improves PDR or ADR. More studies are needed for final conclusions, particularly on HBB’s effect on PPP and APP.

Section snippets

Search strategy

A recursive electronic search was conducted by using MEDLINE and EMBASE to identify eligible trials by using the following keywords: spasmolytic agent, antispasmodic agent, hyoscine-N-butylbromide, colonoscopy, adenoma detection, and cecal intubation. The detailed search strategy is shown in Appendix 1 (available online at www.giejournal.org). Manual searches were performed for related abstracts published in major international conferences over the past 5 years, including Digestive Disease

Results

The initial search, performed in October 2013, led to the identification of 510 potentially eligible records. Screening of titles resulted in exclusion of 485 records. Of the remaining 25 records, 12 were excluded on the basis of the abstract. After we evaluated the full text, 8 of 13 eligible articles were eventually excluded (Fig. 1) because they evaluated HBB as premedication for colonoscopy, or they were focused mostly on technical or safety issues and did not report clinical outcomes (ie,

Discussion

The present meta-analysis showed that the administration of 20 mg HBB, at time of cecal intubation, does not improve detection of polyps or adenomas. HBB is used routinely by radiologists for CT colonography and barium enemas to decrease colon motility and facilitate mucosal exploration.15, 28 It also is used by gastroenterologists during colonoscopy, primarily to facilitate cecal intubation. Nevertheless, data about the impact of HBB administration on polyp detection are controversial. In

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this article.

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    Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.