Hyoscine N-butylbromide does not improve polyp detection during colonoscopy: a double-blind, randomized, placebo-controlled, clinical trial - 21/03/12
Reprint requests: F. ter Borg, MD, PhD, Department of Gastroenterology, Deventer Hospital, Nico Bolkesteinlaan 74, 7416 SE Deventer, The NetherlandsRésumé |
Background |
Colonoscopy is used for the detection of neoplastic polyps, although a significant miss rate has been reported. Limited data suggest that the administration of the antispasmodic hyoscine N-butylbromide during colonoscopy improves polyp detection.
Objective |
To investigate whether the use of 20 mg hyoscine N-butylbromide intravenously during colonoscopy improves polyp detection or removal.
Design |
A prospective, double-blind, placebo-controlled, randomized, clinical trial.
Setting |
Nonacademic teaching hospital.
Patients |
This study involved 674 patients who were routinely referred and accepted for either diagnostic or screening colonoscopy.
Intervention |
Intravenous injection of either 1 mL hyoscine N-butylbromide (n = 340) or 0.9% NaCl solution (n = 334) when withdrawal was started.
Main Outcome Measurements |
Polyp detection rate (PDR), adenoma detection rate (ADR), and the advanced lesion detection rate (ALDR), 5% trimmed mean number of polyps, mean withdrawal time.
Results |
The cecal intubation rate was 96%. The PDR, ADR, and ALDR were 56% versus 60%, 30% versus 31%, and 14% versus 14% in the hyoscine N-butylbromide and placebo groups, respectively (all P values > .25). The means of the total number of detected, removed, and harvested polyps per patient were 1.13 versus 1.21, 1.03 versus 1.06, and 0.89 versus 0.89 in the hyoscine N-butylbromide and placebo groups, respectively (all P values > .37). Mean withdrawal time was 561 versus 584 seconds in the hyoscine N-butylbromide and placebo groups, respectively (P = .34). Multivariate analysis demonstrated no effect of hyoscine N-butylbromide on the investigated parameters.
Limitations |
Only experienced colonoscopists participated in the study.
Conclusion |
We found no evidence to support the use of hyoscine N-butylbromide during withdrawal of the colonoscope to improve polyp detection or removal. (Clinical trial registration number: ISRCTN25405865.)
Le texte complet de cet article est disponible en PDF.Abbreviations : ADR, ALDR, BBPS, PDR
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
Vol 75 - N° 4
P. 835-840 - avril 2012 Retour au numéro
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