Usefulness of Shakuyaku-kanzoh-to (TJ-68), a Herbal Medicine, as an Antispasmodic Agent by Direct Spraying During Colonoscopy

Abstract

Background and aims: Regarding colonoscopy, the endoscope is often difficult to insert and observation tends to be deteriorated because of colonic spasms. Therefore, colonoscopy is sometimes complicated for patients in whom anti-cholinergic agents are contraindicated, such as those with glaucoma or heart disease, as well as for the endoscopist. Herbal medicine Shakuyaku-kanzoh-to (TJ-68) has antispasmodic effects on skeletal muscle and smooth muscle in vitro, and it is clinically used to relieve muscle cramps. Thus, we tried to apply TJ-68 to colonoscopic examination as an antispasmodic agent. In a previous study, it was reported that intraluminal administration of peppermint oil solution reduced colonic spasms, but the preparation of this solution was complicated and the reported evaluation method was subjective. The aim of this study was to objectively evaluate the effect of TJ-68 on colonic spasms during colonoscopy. Materials and methods: Eighty patients undergoing screening colonoscopy, were randomly assigned to two groups: TJ-68 in 40 subjects and saline as the control in 40. The endoscope (CF-Q240I; Olympus Optical Co. Ltd) was inserted up to about 20 cm from the anal canal into the sigmoid colon. Then, a spastic region was identified and while keeping a distance of about 10mm between the spastic region and the tip of the colonoscope, the endoscopic view was recorded on digital videotape for 3 minutes before and after spraying the TJ-68 solution or saline through a working channel. Twelve spot images were selected every 30 minutes to assess luminal changes. The intraluminal area of the spastic region was measured using a computer image analyzer (Adobe Photoshop 7.0) and expressed as pixel counts. The areas under the curve (AUC) were calculated from the pixel curve obtained before and after spraying TJ-68. Informed consent was obtained from all the subjects. Statistical significance was assessed by Student's t-test. Results: The mean AUC before and after TJ-68 spraying was 23108 pixels and 99384 pixels, respectively, while in the case of saline, they were 24718 pixels and 43034 pixels, respectively. Thus, the AUC significantly increased after TJ-68 spraying compared with the spraying of saline (p<0.001). Conclusion Direct spraying of TJ-68 on the colonic mucosa obviously proved to suppress colonic spasm. TJ-68 was suggested to be more useful than peppermint oil solution for premedication of the colonoscopy when anticholinergic drugs are contraindicated.