An open-label, single-arm study assessing the efficacy and safety of l-menthol sprayed onto the gastric mucosa during upper gastrointestinal endoscopy

Hiki, Naoki; Kaminishi, Michio; Tanabe, Satoshi; Fujisaki, Junko; Yoshino, Junji; Iguchi, Mikitaka; Kobayashi, Hiroyuki; Ashida, Kiyoshi; Kawabe, Takao; Kawano, Tatsuyuki; Nomura, Sachiyo; Yahagi, Naohisa; Tajiri, Hisao; Suzuki, Hiroaki

doi:10.1007/s00535-011-0395-9

Cited by 10 publications

(13 citation statements)

References 28 publications

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“…The frequency of the antiperistaltic effect in this study was higher than that in previous reports. The frequency of gastric aperistalsis before LM administration was more than 70 %, which was comparable with that observed after the administration of LM in previous reports 2 3 10 . The reason for this difference is likely that all subjects in the present study underwent EGD via the transnasal approach.…”

Section: Discussionsupporting

confidence: 91%

“…Gastric peristalsis was evaluated before and after the solution was administered according to the partially modified Niwa classification 2 3 10 : grade 1 (no peristalsis), grade 2 (mild peristalsis), grade 3 (moderate peristalsis), grade 4 (vigorous peristalsis), and grade 5 (markedly vigorous peristalsis). In this study, these classifications were used to divide patients into two groups: a peristaltic suppressed state group (i. e., grade 1 or 2) and a peristaltic state group (i. e., grade 3, 4, or 5).…”

Section: Methodsmentioning

confidence: 99%

“…Esophagogastroduodenoscopy (EGD) is useful for the detection of early gastric cancer because this technique can identify superficial flat and nonulcerative lesions. The suppression of gastric peristalsis promotes the detection of smaller lesions because it facilitates EGD 2 3 . Thus, antispasmodic agents such as butyl scopolamine bromide and glucagon are often injected before EGD to suppress gastric peristalsis.…”

Section: Introductionmentioning

confidence: 99%

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l-Menthol sprayed on gastric mucosa causes edematous change

Mori

Hachiya

Yumura

et al. 2014

EIO

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Background and study aims: l-Menthol (LM), sprayed on the distal gastric mucosa, is a safe antispasmodic agent used during esophagogastroduodenoscopy (EGD). However, it seems to affect gastric mucosal endoscopic findings. Therefore, we evaluated whether LM causes specific changes and impacts the endoscopic morphology of gastric lesions. Patients and methods: A total of 98 patients scheduled to undergo EGD were randomly assigned to receive LM solution (160 mg of 0.8 % LM added to 2.5 mL of indigo carmine [IC]; n = 49; LM group) or decuple-diluted IC solution without LM (n = 49; placebo group). We compared the incidence of specific mucosal changes and the difference in the endoscopic findings of several gastric lesions between these groups. Results: Annular-reticular – like mucosal changes appeared immediately after the administration of LM solution. This change was observed in 71.4 % of the LM group compared with 12.2 % of the placebo group (P < 0.01). In the placebo group, this change was observed in 14.7 % of subjects with atrophic gastritis compared with 6.7 % of those without atrophic gastritis (P = 0.39), whereas in the LM group, this change was observed in 84.8 % of subjects with atrophic gastritis compared with 43.8 % of those without atrophic gastritis (P < 0.01). Most early gastric cancers, erosions, and ulcers observed in this study became well demarcated after LM administration, although the incidence of gastric lesions did not differ significantly between the two groups. Conclusion: LM changes the gastric mucosa into edematous mucosa, and this occurs more frequently in atrophic gastric mucosa than in pathologic lesions. LM may facilitate the demarcation of pathologic gastric lesions without intestinal metaplasia.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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l-Menthol sprayed on gastric mucosa causes edematous change

Mori

Hachiya

Yumura

et al. 2014

EIO

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“…A possible explanation for this difference is that, although we conducted no histological evaluation of the atrophied region or intestinal metaplasia, in the presence of gastric mucosal atrophy, progression from atrophic gastritis to intestinal metaplasia increases the number of absorptive cells at the affected site, thereby resulting in increased absorption of L -menthol and subsequent enhancement of its peristalsis -suppressive effect. Although Hiki et al 7) reported that the rate of complete suppression of gastric peristalsis was 37.5%, it was 78.2% in the present study. This difference is regarded as attributable to the differences in the evaluation time of the gastric peristalsis-suppressive effect.…”

Section: Discussioncontrasting

confidence: 80%

“…This product contains L -menthol as the active ingredient at a concentration of 0.8%, which is lower than that of our internally prescribed peppermint oil. This study was conducted to verify the usefulness of the Lmenthol preparation as an antispasmodic for EGD, as reported previously by Hiki et al, 7) in addition to its effectiveness for detecting and diagnosing gastric tumors.…”

Section: Introductionmentioning

confidence: 70%

Clinical Application of L-Menthol in the Upper Gastrointestinal Endoscopic Procedure

Kikuchi

Hikichi

Takagi

et al. 2015

FJMS

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: Aim : Peppermint oil, which suppresses gastric peristalsis during esophagogastroduodenoscopy (EGD), is effective for determining the margin of a gastric tumor. This study was conducted to evaluate the utility of an L -menthol preparation for suppressing gastric peristalsis and for diagnosing gastric tumors. Methods : The study examined 124 patients who underwent EGD between January and April 2012. After 20 mL of 0.8% L -menthol was sprayed directly onto the mucosal surface of the gastric antrum, the degree of peristalsis suppression in the antrum was evaluated. The effectiveness of Lmenthol for identifying new gastric tumors and determining tumor margins was also evaluated. Results : Gastric peristalsis was suppressed in 88.5% (69/78) of patients, with complete suppression of peristalsis achieved in 78.2%. L -menthol exerted a higher peristalsis -suppressive effect in patients with endoscopic gastric mucosal atrophy (93.3%, 56/60) than in patients without atrophy (72.2%, 13/18) (p = .014). L -menthol application caused the detection of new gastric tumors in 1.6% (2/124) of patients and clarification of the margin of three lesions (in 3 patients) identified as having an unclear margin before L -menthol application. Conclusion : These results suggest that L -menthol is effective for suppressing gastric peristalsis during EGD and suggest that it is useful for identifying gastric tumors and for determining tumor margins.

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Effect of sprayingl‐menthol on peristalsis resumption during endoscopic submucosal dissection of gastric tumors

et al. 2021

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Background and Aim: L-Menthol has smooth muscle-relaxing and antiperistaltic effects. We examined its effectiveness against peristalsis resumption during endoscopic submucosal dissection (ESD) of gastric tumors. Methods: We retrospectively examined clinical data of 485 patients (501 lesions) who underwent ESD for upper gastrointestinal tumors in 2017. We included 119 patients (127 lesions) in whom peristaltic movement resumed during ESD and Lmenthol was applied; 366 patients (374 lesions) without L-menthol application were used as controls. Video recordings were reviewed to determine whether L-menthol suppressed peristalsis resumption. Results: In cases with L-menthol application, 2 (2.9%), 36 (14.3%), and 89 (71.2%) lesions were found in the upper (U), middle (M), and lower (L) regions, respectively. In the control group, the corresponding values were 66 (17.6%), 215 (57.5%), and 93 (24.9%), respectively. L-Menthol efficacy was observed in 116 of the 127 treated lesions (91.3%), over 90% of which were in the posterior wall of the U region, anterior wall and greater curvature of the M region, and anterior wall and lesser curvature of the L region. The most and least effective areas for L-menthol application were the anterior wall of gastric antrum and posterior wall of the M region, respectively. The mean time from application to peristalsis inhibition was 8.7 s. No adverse effects were observed; perforation and secondary hemorrhage were not significantly different between the groups. Conclusion: Direct L-menthol application to the submucosal layer during mucosal resection affects smooth muscles and rapidly inhibits peristalsis resumption. Clinically, L-Menthol can be used to suppress peristalsis recurrence during ESD, without adverse effects.

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An open-label, single-arm study assessing the efficacy and safety of l-menthol sprayed onto the gastric mucosa during upper gastrointestinal endoscopy

Abstract: These findings are comparable to those of the phase III placebo-controlled study and provide further evidence that endoscopic direct spraying of L: -menthol effectively suppresses gastric peristalsis during upper gastrointestinal endoscopy.

Cited by 10 publications

References 28 publications

l-Menthol sprayed on gastric mucosa causes edematous change

l-Menthol sprayed on gastric mucosa causes edematous change

Clinical Application of L-Menthol in the Upper Gastrointestinal Endoscopic Procedure

Effect of sprayingl‐menthol on peristalsis resumption during endoscopic submucosal dissection of gastric tumors

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