Canadian Association of Gastroenterology (CAG) Position Statement on the Use of Hyoscine-n-butylbromide (Buscopan) During Gastrointestinal Endoscopy

Abstract

Hyoscine butylbromide, also known as hyoscyamine or scopolamine, and sold under the trade name Buscopan, is an antimuscarinic agent commonly used to induce smooth muscle relaxation and reduce spasmodic activity of the gastrointestinal (GI) tract during endoscopic procedures. However, the balance between desirable and undesirable (adverse) effects is not clear when used during GI endoscopy. The Clinical Affairs Committee of the Canadian Association of Gastroenterology (CAG) conducted systematic reviews and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations for the use of Buscopan during GI endoscopy. To summarize, we recommend against the use of Buscopan before or during colonoscopy (strong recommendation, high certainty of evidence). We suggest against the use of Buscopan before or during gastroscopy (conditional recommendation, very low certainty of evidence). We suggest the use of Buscopan before or during ERCP (conditional recommendation, very low certainty of evidence). More research is needed to determine whether patients undergoing advanced procedures such as endoscopic mucosal resection or endoscopic submucosal dissection benefit from its use. Buscopan should be used with caution in patients with cardiac comorbidities. According to its product monograph, Buscopan is contraindicated in patients with tachycardia, angina, and cardiac failure. Thus, Buscopan should be used very cautiously in patients with these conditions, and only when the potential benefits of its use outweigh the potential risks in a particular case. Such patients require careful cardiac monitoring in an environment where resuscitation equipment and appropriately trained staff to use it are readily available. According to its product monograph, Buscopan is also contraindicated in patients with prostatic hypertrophy with urinary retention, and therefore, should be used very cautiously in such patients as well, and only when the potential benefits of its use outweigh the potential risks in a particular case. Obtaining a preprocedural history of glaucoma is unlikely to be of value when considering Buscopan use. However, in cases where Buscopan has been used, patients should be counselled postprocedurally and told to present to an emergency facility should they experience eye pain, redness, decreased vision, nausea and vomiting or headache.

Provider-reported use of butylscopolamine in gastrointestinal endoscopy in Germany

“…Based on this the Canadian Association of Gastroenterology recommends HBB use during ERCP [7]. In line with this our respondents state that they frequently employ HBB during ERCP -more so than during any other procedure.…”

“…International guidelines are inconsistent with regard to HBB use: Asian consensus statements recommend the use of spasmolytics to improve lesion detection in diagnostic EGD [27] and during screening colonoscopy [28]. Conversely, the Canadian Association of Gastroenterology advises against the use of HBB during diagnostic EGD and screening colonoscopy [7]. Guideline recommendations addressing interventional procedures in the upper GI tract do not exist to This article is protected by copyright.…”

“…and all available metanalyses indicate that there is no significant benefit of HBB with regard to ADR, PDR and cecal intubation rate [7,[9][10][11][12].…”

“…The use of HBB in diagnostic gastrointestinal endoscopy has been investigated and the available evidence has recently been summarized in a position statement by the Canadian Association of Gastroenterology [7]. The majority of studies focus on colonoscopy and evaluate effects of HBB on parameters relevant to colonoscopy quality such as cecal intubation time and rate, withdrawal time, mucosal visualization, and adenoma/ polyp detection rate (ADR/PDR).…”

Interventions to improve the quality of screening-related colonoscopy: protocol for a systematic review and network meta-analysis of randomised controlled trials

“…Several interventions exist that aim to improve ADR. Broadly, these can be categorised into several domains, including preprocedural and periprocedural considerations (eg, optimised bowel cleansing 13 and sedation regimens 14 ), endoscopist-directed interventions (eg, directed audit and feedback 15 or educational courses 16 ), intraprocedural techniques (eg, dynamic positional changes 17 or second-look examination 18 ), endoscopy technologies (eg, advanced imaging 19 or computer-aided detection, CADe 19 ), disposable assistive devices (eg, cuffs 20 or rings 21 ) and additive substances (eg, hyoscine-n-butylbromide 22 ).…”