Hyoscine butylbromide for colorectal polyp detection: prospective, randomized, placebo-controlled trial

Abstract

OBJECTIVES:The removal of pre-malignant colorectal lesions prevents cancer. Hyoscine has been proposed as a means of improving diagnosis by reducing colonic movements. The aim of this study was to analyze whether this anti-spasmodic enhances the detection of pre-malignant colorectal lesions.METHODS:In a randomized, double-blinded fashion patients received hyoscine or a saline solution in all consecutive colonoscopies in which the cecum was reached. Lesions were analysed with respect to number, size, location, histology and capillary pattern.RESULTS:A total of 440 colonoscopies were randomized. The overall polyp detection rate (PDR) and the adenoma detection rate (ADR) were 65.2% and 49.3%, respectively. In the hyoscine group, non-polypoid lesions were detected significantly more often (p=0.01). In the placebo group 281 lesions were diagnosed (202 adenomas) and in the hyoscine group 282 lesions were detected (189 adenomas) (p=0.23). The PDR and ADR were similar between the placebo and hyoscine groups (64% vs 66% and 50% vs 47%, respectively). No differences were observed between the two groups in the advanced-ADR or advanced neoplasia detection rate, as well the mean numbers of polyps, adenomas, advanced adenomas and advanced neoplasias detected per patient. The administration of hyoscine also did not improve the diagnostic accuracy of digital chromoendoscopy. The presence of adenomatous polyps in the right colon was detected significantly more frequently in the hyoscine group (OR 5.41 95% CI 2.7 - 11; p<0.01 vs OR 2.3 95% CI 1.1 - 4.6; p=0.02).CONCLUSION:The use of hyoscine before beginning the withdrawal of the colonoscope does not seem to enhance the PDR and the ADR.

Does Hyoscine improve polyp detection rate during colonoscopy? Systematic Review & meta-analysis of randomized clinical trials

“…After screening titles and abstracts, 16 papers were selected for full-text review. After applying the eligibility criteria, eight of these studies included in the meta-analysis [ [10] , [11] , [12] , [13] , [14] , [20] , [21] , [22] ]. The PRISMA flow diagram is shown in Fig.…”

“…PDR was considered the primary outcome in this meta-analysis. Eight RCTs assessed PDR [ [10] , [11] , [12] , [13] , [14] , [20] , [21] , [22] ]. These trials included 2708 patients, of whom 1360 patients received Hyoscine Butylbromide and 1348 were allocated in the placebo group.…”

“…Five RCTs assessed the ADR [ 10 , 11 , 13 , 14 , 21 ] (n = 2322). There was no significant difference in ADR between the Hyoscine and placebo groups (394/1168, 33.7% vs 359/1154, 31%; OR = 1.13;…”

“…Pooled data showed no statistically significant difference between the groups. Eight studies evaluated PDR [ [10] , [11] , [12] , [13] , [14] , [20] , [21] , [22] ] and five studies assessed ADR [ 10 , 11 , 13 , 14 , 21 ]. This meta-analysis showed no significant effect of Hyoscine on PDR and ADR.…”

Impact of Hyoscine Bromide Use on Polyp Detection Rate During Colonoscopy: A Systematic Review and Meta-Analysis

“…Corte et al demonstrated higher polyp rate in HBB group when administered after cecal intubation as compared to placebo group [ 6 ]. Santos et al in their recently published RCT found a higher rate of non-polypoid lesions in the HBB group as compared to placebo group [ 7 ]. Lee at al showed that in a selected subgroup of patients with intense colonic spasms using non validated spasm score > 3 HBB group had more significant ADR compared to placebo group [ 8 ].…”