The Efficacy of Antispasmodic Drugs for Colonoscopy: Is There Difference Between Glucagon and Scopolamine?

Abstract

Background: Antispasmodic agents are used to decrease colonic spasm and facilitate colonoscope manipulation and visualization. However, there have been some controversy and preference with regard to the types of antispasmodics. Although glucagon is believed to be safer for the patients with cardiovascular diseases, it might be weak to reduce spasm effectively especially without using sedatives. Tailor-maid use of antispasmodics may be better to manage the increasing demand for colonoscopies. This study aimed to evaluate the effect of antispasmodics in consideration of the types of the agents. [MATERIALS and METHOS] We reviewed 1189 examinations of the first colonoscopy from August 2005 to March 2008 in our hospital, excluding emergent or therapeutic procedures. Colonoscopies were conducted by trainees without sedation. Cecal intubation rate, intubation time, cecal intubation rate within 10 min were evaluated in association with the use of antispasmodic agents. Results: Sixty-six examinations were performed without antispasmodics, 197 using glucagons, and 926 using scopolamine butylbromide. The overall cecal intubation rate was 89.4%, 93.9%, and 96.3%, respectively (P=0.033). Cecal intubation time was 19.0, 16.1, and 14.5 min., respectively. Cecal intubation time was significantly shorter when using antispasmodic medication than using no medication, and the use of scopolamine butylbromide seemed to be more effective . The intubation rate within 10 minutes were significantly higher in scopolamine butylbromide group (26.3% [18/66], 36.6% [72/197], and 45.6% [422/926], P < 0.001). A multivariate analysis controling age, sex, body mass index, surgical history of abdomen and use of hood attachment showed that the use of scopolamine butylbromide was associated with successful cecal intubation within 10 minutes (OR 2.19, 95%CI 1.54-6.59, P = 0.0018). [CONCLUTION] The use of scopolamine butylbromide was suggested to be more effective than glucagon for the improvement of cecal intubation rate and shortening of intubation time in colonoscopy.