Comparison between the Effectiveness of Oral Phloroglucin and Cimetropium Bromide as Premedication for Diagnostic Esophagogastroduodenoscopy: An Open-Label, Randomized, Comparative Study

Abstract

Background/AimsSuppression of gastrointestinal (GI) peristalsis during GI endoscopy commonly requires antispasmodic agents such as hyoscine butylbromide, atropine, glucagon, and cimetropium bromide. This study examined the efficacy of oral phloroglucin for the suppression of peristalsis, its impact on patient compliance, and any associated complications, and compared it with intravenous or intramuscular cimetropium bromide administration.MethodsThis was a randomized, investigator-blind, prospective comparative study. A total of 172 patients were randomized into two groups according to the following medications administered prior to upper endoscopy: oral phloroglucin (group A, n=86), and cimetropium bromide (group B, n=86). The numbers and the degrees of peristalsis events at the antrum and second duodenal portion were assessed for 30 seconds.ResultsA significantly higher number of gastric peristalsis events was observed in group A (0.49 vs. 0.08, p<0.001), but the difference was not clinically significant. No significant difference between both groups was found in the occurrence of duodenal peristalsis events (1.79 vs. 1.63, p=0.569). The incidence of dry mouth was significantly higher with cimetropium bromide than with phloroglucin (50% vs. 15.1%, p<0.001).ConclusionsOral phloroglucin can be used as an antispasmodic agent during upper endoscopy, and shows antispasmodic efficacy and adverse effects similar to those of cimetropium bromide.

Effectiveness of oral phloroglucinol as a premedication for unsedated esophagogastroduodenoscopy: A prospective, double-blinded, placebo-controlled, randomized trial

“…Most adverse events were mild and spontaneously resolved with no additional management requirement. These findings are consistent with a previous study that demonstrated no serious adverse events during the study period [ 14 ]. Furthermore, the incidence of dry mouth was significantly lower in patients treated with phloroglucinol than in those treated with cimetropium bromide during diagnostic EGD [ 14 ].…”

“…Before the study, the efficacy of oral phloroglucinol as a premedication for EGD had not been extensively evaluated. Only one study compared the suppression of peristalsis during diagnostic EGD between oral phloroglucinol and intravenous cimetropium bromide [ 14 ]. Oral phloroglucinol was inferior to cimetropium bromide in inhibiting gastric peristalsis, but the difference was not clinically significant.…”

“…Oral phloroglucinol was inferior to cimetropium bromide in inhibiting gastric peristalsis, but the difference was not clinically significant. Therefore, the authors postulated that oral phloroglucinol can be used as an antispasmodic agent during EGD with similar antispasmodic efficacy as cimetropium bromide [ 14 ]. Consistent with this previous report, our study showed that oral phloroglucinol significantly suppressed gastric peristalsis in patients undergoing unsedated EGD and that it demonstrated acceptable safety.…”

“…Furthermore, oral phloroglucinol is a transparent liquid that does not interfere with the endoscopic field of view and may therefore be suitable as a pre-treatment agent. A recent study on oral phloroglucinol as a premedication for diagnostic EGD showed promising results, but that study lacked a placebo control [ 14 ]. Therefore, we aimed to evaluate the effectiveness of oral phloroglucinol as a premedication for non-sedative EGD in a randomized, double-blinded, placebo-controlled trial.…”

Cimetropium bromide does not improve polyp and adenoma detection during colonoscope withdrawal

“…Cimetropium bromide is widely used to inhibit peristalsis and improve visualization during colonoscopy in South Korea. [ 30 ] The antispasmodic effect of cimetropium bromide begins promptly (within 1 minute) after injection and has a half-life of 50 minutes. [ 31 ] Cimetropium-related side effects include mild tachycardia and dry mouth.…”