535 Peppermint Oil Decreases Colonic Spasm Without Significantly Affecting Cecal Intubation Time and Adenoma Detection Rate: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: Peppermint oil, an essential oil well known as a flavoring agent, is also known to have a relaxation effect on smooth muscles in the colon. Peppermint oil was reported to reduce colonic spasm and is commonly used for symptomatic relief in irritable bowel syndrome. Whether these effects lead to clinically relevant advantages in practice during routine colonoscopy is controversial. METHODS: We included randomized controlled trials comparing peppermint oil administered during colonoscopy to placebo. We searched Medline, Google Scholar, and Cochrane through May 2019. Eligible studies were searched for variables of interest including inhibition of peristalsis cecal intubation time, and adenoma detection rate (ADR). All statistical analyses were performed using the R Programming Language. Pooled rates of variables were reported as Odds ratio (OR) and standardized mean difference with 95% confidence interval and heterogeneity was reported as I2 statistics. RESULTS: A total of 5 trials were eligible and included in the analysis. Dosage and route of administration were variable, peppermint oil was administered via oral dose pre-procedure in 2 studies and locally during the procedure in 3 studies. There was a total of 623 subjects in the peppermint oil group and 239 in the placebo group. Complete inhibition of colonic peristalsis was significantly more common in the peppermint oil group (OR = 6.12, 1.85-20.26). Cecal intubation time and ADR were comparable between the 2 study groups. There was substantial heterogeneity. CONCLUSION: Administration of peppermint oil reduces colonic spasm during colonoscopy. Despite the theoretical benefits of improving mucosal inspection and increasing the ease of colonoscopy insertion with peppermint oil, objective measurements including ADR and cecal intubation time did not differ. However, these studies were limited by the low number of subjects, significant heterogeneity in dosage, route and timing of administration. Given the heterogeneity of the results, larger randomized controlled trials are needed.