title: Hyoscine N-butylbromide for adenoma detection during colonoscopy: a randomized, double-blind, placebo-controlled study.
abstract: BACKGROUND
  Hyoscine N-butylbromide (HBB), commonly used during colonoscopy to facilitate cecal intubation, has been proposed to increase the adenoma detection rate (ADR).
  
  
  OBJECTIVE
  To evaluate whether HBB administration increases the adenoma detection rate and influences patients' tolerance.
  
  
  METHODS
  Consecutive colonoscopy outpatients were randomized after cecal intubation to receive either 20mg HBB or placebo i.v. The number, size, histology and location of polyps were recorded. The air retained in the abdomen was either indirectly estimated by ΔAC (difference in the abdominal circumference measured before and after colonoscopy) or directly evaluated by patients' perception (visual analogic scale, range 0-100).
  
  
  RESULTS
  402 patients (44% male; mean age 57.7±12.5years) received either HBB or placebo. No differences in ADR (31.7% vs. 28%, p=0.48), advanced-ADR (7.4% vs. 10.5%, p=0.35) were observed between HBB and placebo group, respectively. A significantly lower detection rate of flat/depressed lesions was observed in the HBB group (0.5% vs. 5.5%, p=0.003). The ΔAC and the bloating perception were comparable between the two groups (p=0.22 and p=0.48, respectively).
  
  
  CONCLUSIONS
  HBB administered before colonoscope withdrawal does not increase adenoma detection rate and seems to hamper the visualization of flat/depressed lesions. This finding raises concerns on the indiscriminate use of HBB during colonoscopy.
authors.affiliation: Gastroenterology Unit, Ospedale Valduce, Como, Italy. ema.rondo@gmail.com
authors.forename: Emanuele
authors.initials: E
authors.lastname: Rondonotti
authors.forename: Franco
authors.initials: F
authors.lastname: Radaelli
authors.forename: Silvia
authors.initials: S
authors.lastname: Paggi
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Amato
authors.forename: Gianni
authors.initials: G
authors.lastname: Imperiali
authors.forename: Vittorio
authors.initials: V
authors.lastname: Terruzzi
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mandelli
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Lenoci
authors.forename: Natalia L
authors.initials: NL
authors.lastname: Terreni
authors.forename: Alessandra
authors.initials: A
authors.lastname: Baccarin
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Spinzi
mesh_terms: D018256:Adenomatous Polyps / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002086:Butylscopolammonium Bromide; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003111:Colonic Polyps / Q000175:diagnosis; D003113:Colonoscopy; D003287:Contrast Media; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D003287:Contrast Media; D002086:Butylscopolammonium Bromide
keywords: Adenoma detection; Colonoscopy; Hyoscine N-butylbromide