title: Optimizing colonic distention for multi-detector row CT colonography: effect of hyoscine butylbromide and rectal balloon catheter.
abstract: OBJECTIVE
  To investigate the effects of hyoscine butylbromide and an inflatable rectal balloon catheter on luminal distention during computed tomographic (CT) colonography.
  
  
  METHODS
  One hundred thirty-six subjects undergoing CT colonography were randomized to receive either 20 mg or 40 mg of hyoscine butylbromide or no spasmolytic. Subjects were also independently randomized to undergo CT colonography with an inflatable rectal balloon catheter or a standard thin rectal tube. Multi-detector row CT colonography was performed with patients in prone and supine positions, with colonic segmental distention assessed by a single observer with a four-point scale. A simple assessment of whether distention was adequate for clinical interpretation was also made, and the effect of hyoscine butylbromide and catheter use was examined by using multivariate ordered logistic regression.
  
  
  RESULTS
  Administration of hyoscine butylbromide was associated with significantly improved cecal (P =.05), ascending (P =.001), and transverse (P <.001) colonic distention when patients were supine and improved ascending (P <.001) and descending (P <.001) colonic distention when patients were prone. Compared with control subjects, patients given a spasmolytic had odds of 6.49 for clinically adequate distention throughout all colonic segments (P =.001). There was no incremental advantage with use of a 40-mg dose. In contrast, rectal balloon catheter use was not significantly associated with improved distention.
  
  
  CONCLUSIONS
  Hyoscine butylbromide improves colonic distention during CT colonography and should be routinely administered where it is available. Use of a thin rectal tube for insufflation is adequate.
authors.affiliation: Intestinal Imaging Centre and Cancer Research UK Colorectal Cancer Unit, Level 4V, St Mark's Hospital, Watford Rd, Northwick Park, Harrow, Middlesex HA1 3UJ, England.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Taylor
authors.forename: Steve
authors.initials: S
authors.lastname: Halligan
authors.forename: Vicky
authors.initials: V
authors.lastname: Goh
authors.forename: Simon
authors.initials: S
authors.lastname: Morley
authors.forename: Paul
authors.initials: P
authors.lastname: Bassett
authors.forename: Wendy
authors.initials: W
authors.lastname: Atkin
authors.forename: Clive I
authors.initials: CI
authors.lastname: Bartram
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002086:Butylscopolammonium Bromide / Q000494:pharmacology*; D002404:Catheterization; D003106:Colon / Q000000981:diagnostic imaging* / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010276:Parasympatholytics / Q000494:pharmacology*; D011187:Posture; D012007:Rectum; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D010276:Parasympatholytics; D002086:Butylscopolammonium Bromide