Hyoscine for polyp detection during colonoscopy: A meta-analysis and systematic review

Abstract

AIM:To assess the role of hyoscine for polyp detection during colonoscopy. METHODS: Studies (randomized controlled trials orRCTs) that compared the use of hyoscine vs no hyoscine or placebo for polyp detection during colonoscopy were included in our analysis. A search on multiple databases was performed in September 2013 with search terms being "hyoscine and colonoscopy", "hyoscine and polyp", "hyoscine and adenoma", "antispasmotic and colonoscopy", "antispasmotic and adenoma", and "antispasmotic and polyp". Jadad scoring was used to assess the quality of studies. The efficacy of hyoscine was analyzed using Mantel-Haenszel model for polyp and adenoma detection with odds ratio (OR). The I 2 measure of inconsistency was used to assess heterogeneity (P < 0.05 or I 2 > 50%). Statistical analysis was performed by RevMan 5.1. Funnel plots was used to assess publication bias. RESULTS:The search of the electronic databases identified 283 articles. Of these articles, eight published RCTs performed at various locations in Europe, Asia, and Australia were included in our meta-analysis, seven published as manuscripts and one published as an abstract (n = 2307). All the studies included patients with a hyoscine and a no hyoscine/placebo group and were of adequate quality (Jadad score ≥ 2). Eight RCTs assessed the polyp detection rate (PDR) (n = 2307). The use of hyoscine demonstrated no statistically significant difference as compared to no hyoscine or placebo for PDR (OR = 1.06; 95%CI: 0.89-1.25; P = 0.51). FiveRCTs assessed the adenoma detection rate (ADR) (n = 2015). The use of hyoscine demonstrated no statistically significant difference as compared to no hyoscine or placebo for ADR (OR = 1.12; 95%CI: 0.92-1.37; P = 0.25). Furthermore, the timing of hyoscine administration (given at cecal intubation or pre-procedure) demonstrated no differences in PDR compared to no hyoscine or placebo. Publication bias or heterogeneity was not observed for any of the outcomes. CONCLUSION:Hyoscine use in patients undergoing colonoscopy does not appear to significantly increase the detection of polyps or adenomas.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Hyoscine; Antispasmodic; Polyp detection; Colonoscopy Core tip: Hyoscine is used in clinical practice to decrease spasms in the colon during colonoscopy in an effort to improve polyp or adenoma detection. However, this study shows that hyoscine given before the procedure or at time of cecal intubation does not improve polyp or adenoma detection.

Standards of diagnostic colonoscopy for early‐stage neoplasia: Recommendations by an Asian private group

“…Therefore, giving antispasmodic agents to minimize technical difficulties and patient discomfort is still controversial. Recently, several meta‐analyses on the use of antispasmodic agents during colonoscopy for lesion detection have been published . None of them concluded that the use of antispasmodic agents improved the detection rate of either adenomas or polyps.…”

“…Recently, several meta-analyses on the use of antispasmodic agents during colonoscopy for lesion detection have been published. [25][26][27][28] None of them concluded that the use of antispasmodic agents improved the detection rate of either adenomas or polyps. However, one RCT showed that hyoscine butylbromide increased the number of polyps identified per patient.…”

How Can We Improve Adenoma Detection Rate?

“…A recent meta-analysis based upon the finding of eight RCTs conducted in Europe, Asia and Australia concluded that hyoscine use in patients undergoing colonoscopy does not appear to significantly increase the detection of adenomas [10]. Contrary to this, a study examining the use of different antispasmodic that is applied topically during the procedure: L-menthol (an organic compound found in peppermint oil), demonstrated an improved ADR [11].…”

Improving the utility of colonoscopy: Recent advances in practice

“…165,166 Hyoscine butylbromide may increase mucosal view and polyp detection. 167 No fewer than four systematic reviews and metaanalyses [168][169][170][171] have been published on the eight trials in this area, 154,[172][173][174][175][176][177][178] which draw differing conclusions. While metaanalysis does not demonstrate increased polyp detection with hyoscine butylbromide, several of the analyzed studies 154,178 did not have polyp detection or adenoma detection as their primary endpoint, and some are of low quality.…”