Hyoscine N-butylbromide does not improve polyp detection during colonoscopy: a double-blind, randomized, placebo-controlled, clinical trial.
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.


METHODS
A prospective, double-blind, placebo-controlled, randomized, clinical trial.


METHODS
Nonacademic teaching hospital.


METHODS
This study involved 674 patients who were routinely referred and accepted for either diagnostic or screening colonoscopy.


METHODS
Intravenous injection of either 1 mL hyoscine N-butylbromide (n = 340) or 0.9% NaCl solution (n = 334) when withdrawal was started.


METHODS
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.


CONCLUSIONS
Only experienced colonoscopists participated in the study.


CONCLUSIONS
We found no evidence to support the use of hyoscine N-butylbromide during withdrawal of the colonoscope to improve polyp detection or removal. (


BACKGROUND
ISRCTN25405865.).
Department of Gastroenterology, Deventer Hospital, Deventer, The Netherlands.
Esther J
EJ
de Brouwer
Maurits E
ME
Arbouw
Wil C
WC
van der Zwet
Margot A
MA
van Herwaarden
Michiel
M
Ledeboer
Frank G
FG
Jansman
Frank
F
ter Borg
D000236:Adenoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002086:Butylscopolammonium Bromide; D002432:Cecum; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003111:Colonic Polyps / Q000175:diagnosis* / Q000628:therapy; D003113:Colonoscopy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007440:Intubation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010276:Parasympatholytics; D013997:Time Factors
D010276:Parasympatholytics; D002086:Butylscopolammonium Bromide