title: The impact of hyoscine-N-butylbromide on adenoma detection during colonoscopy: meta-analysis of randomized, controlled studies.
abstract: BACKGROUND
  Hyoscine-N-butylbromide (HBB) can induce flattening of colon folds through inhibition of smooth muscle activity, which improves mucosal visualization. Whether this affects polyp detection is controversial.
  
  
  OBJECTIVE
  To evaluate whether HBB, administered during colonoscopy, improves polyp and adenoma detection.
  
  
  METHODS
  We performed a comprehensive search in MEDLINE and EMBASE databases to identify randomized, placebo-controlled trials (RCTs) in which HBB was administered during colonoscopy and which also reported the detection rate for polyps and/or adenomas (PDR and/or ADR, respectively).
  
  
  METHODS
  Meta-analysis of 5 RCTs.
  
  
  METHODS
  A total of 1998 patients (1006 receiving HBB) were included in the study.
  
  
  METHODS
  Intravenous administration of 20 mg (2 mL) HBB or 2 mL saline solution at the time of cecal intubation.
  
  
  METHODS
  The PDR was the primary outcome variable. Secondary outcomes included the ADR, the advanced adenoma detection rate (adv-ADR), and the mean number of polyps and adenomas per patient (PPP and APP, respectively).
  
  
  RESULTS
  The PDR, ADR, and adv-ADR did not differ significantly between the 2 groups. The odds ratios (95% confidence interval [CI]) for PDR, ADR, and adv-ADR were 1.09, 95% CI, 0.91-1.31; 1.13, 95% CI, 0.92-1.38; and 0.9, 95% CI, 0.63-1.30, respectively. In addition, no significant differences were observed in PPP and APP between the 2 groups.
  
  
  CONCLUSIONS
  Small number of studies included. Limited data about secondary outcomes and safety.
  
  
  CONCLUSIONS
  Our meta-analysis does not provide evidence that routine HBB administration at cecal intubation improves PDR or ADR. More studies are needed for final conclusions, particularly on HBB's effect on PPP and APP.
authors: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors: Emanuele
authors: E
authors: Rondonotti
authors: Institute of Pharmacology of Natural Products and Clinical Pharmacology, University of Ulm, Ulm, Germany.
authors: Oliver
authors: O
authors: Zolk
authors: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors: Arnaldo
authors: A
authors: Amato
authors: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors: Silvia
authors: S
authors: Paggi
authors: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors: Alessandra
authors: A
authors: Baccarin
authors: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors: Giancarlo
authors: G
authors: Spinzi
authors: Gastroenterology Unit, Ospedale Valduce, Como, Italy.
authors: Franco
authors: F
authors: Radaelli
mesh_terms: D000236:Adenoma / Q000175:diagnosis; D018256:Adenomatous Polyps / Q000175:diagnosis*; D002086:Butylscopolammonium Bromide; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003111:Colonic Polyps / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods*; D006801:Humans; D018727:Muscarinic Antagonists; D016032:Randomized Controlled Trials as Topic
chemical_list: D018727:Muscarinic Antagonists; D002086:Butylscopolammonium Bromide