Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(01): E36-E42
DOI: 10.1055/a-2189-0373
Original article

Provider-reported use of butylscopolamine in gastrointestinal endoscopy in Germany

Octavia Ullmann
1   Gastroenterology, Asklepios Klinik Barmbek, Hamburg, Germany (Ringgold ID: RIN38169)
,
Daniel Ranti
2   Institute of Medical Education, Icahn School of Medicine at Mount Sinai, New York, United States (Ringgold ID: RIN5925)
,
Ekaterini Georgiadou
3   Psychiatry and Psychotherapy, Paracelsus Private Medical University – Nuremberg Campus, Nurnberg, Germany (Ringgold ID: RIN470426)
,
Thomas Hillemacher
3   Psychiatry and Psychotherapy, Paracelsus Private Medical University – Nuremberg Campus, Nurnberg, Germany (Ringgold ID: RIN470426)
,
Arthur Schmidt
4   Gastroenterology, Hepatology and Endocrinology, Robert Bosch Hospital, Stuttgart, Germany (Ringgold ID: RIN15000)
,
Thomas von Hahn
1   Gastroenterology, Asklepios Klinik Barmbek, Hamburg, Germany (Ringgold ID: RIN38169)
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction The anti-cholinergic agent hyoscine-N-butylbromide (HBB) is used in gastrointestinal (GI) endoscopy to decrease motility and facilitate endoscopic procedures. Data from clinical studies to support this practice is limited especially for therapeutic procedures. Likewise, patterns of use among endoscopist are largely unclear. This study sought to assess usage of HBB among German-speaking endoscopists.

Material and Methods We conducted an anonymous online survey among endoscopists in German-speaking countries.

Results A total of 207 physicians participated in the survey. The majority (76.9%) were experienced endoscopists and 92.3% of respondents use HBB at least occasionally during procedures. The reported median stated frequency of HBB use varied greatly between different types of procedures and increased with the complexity of the procedure being performed. HBB was rarely used in diagnostic esophagogastroduodenoscopies (EGD) (median stated frequency 1% of procedures), while use frequency was significantly higher in EGD with endoscopic mucosal resection (EMR) (10%; p=0.002) and EGD with endoscopic submucosal dissection (ESD) (20%; p<0.001). Similarly, use frequency during diagnostic colonoscopy was lower (5%) compared to colonoscopy with EMR (20%, p=0.005) or ESD (42.5%, p<0.001). The highest use frequency was reported for ERCP (50%). The most frequently stated reason to use HBB was facilitation of the procedure (80.6%) followed by increasing diagnostic yield (58.3%).

Conclusion German-speaking endoscopists commonly use HBB, most frequently to facilitate complex therapeutic procedures. Given there is almost no data supporting HBB use in therapeutic endoscopy, we suggest that more research is needed to evaluate benefits and risks of this practice.

Keywords

Quality and logistical aspects - Performance and complications - Diagnostic ERC


Publication History

Received: 13 April 2023

Accepted after revision: 14 September 2023

Accepted Manuscript online:
10 October 2023

Article published online:
05 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Tytgat GN. Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain. Drugs 2007; 67: 1343-1357 DOI: 10.2165/00003495-200767090-00007. (PMID: 17547475)
    CrossrefPubMedGoogle Scholar
  • 2 Chen GA-O, Hsu WH. Hyoscine-N-butyl-bromide-induced hypotension and myocardial ischemia. Case Rep Crit Care 2013; 2013: 414856
    PubMedGoogle Scholar
  • 3 Government of the UK. Medicines and Healthcare products Regulatory Agency. Hyoscine butylbromide (Buscopan) injection: risk of serious adverse effects in patients with underlying cardiac disease. Drug Safety Update 20 February 2017. https://www.gov.uk/drug-safety-update/hyoscine-butylbromide-buscopan-injection-risk-of-serious-adverse-effects-in-patients-with-underlying-cardiac-disease
    PubMedGoogle Scholar
  • 4 Dyde R, Chapman AH, Gale R. et al. Precautions to be taken by radiologists and radiographers when prescribing hyoscine-N-butylbromide. Clin Radiol 2008; 63: 739-743
    CrossrefPubMedGoogle Scholar
  • 5 Hradsky M, Stockbrügger R, Stockbrügger R. et al. The use of glucagon during upper gastrointestinal endoscopy. Gastrointest Endosc 1974; 20: 162
    CrossrefPubMedGoogle Scholar
  • 6 You Q, Li L, Chen H. et al. L-menthol for gastrointestinal endoscopy: a systematic review and meta-analysis. Clin Transl Gastroenterol 2020; 11: e00252 DOI: 10.14309/ctg.0000000000000252. (PMID: 33031198)
    CrossrefPubMedGoogle Scholar
  • 7 Forbes N, Frehlich L, Borgaonkar M. et al. Canadian Association of Gastroenterology (CAG) Position Statement on the Use of Hyoscine-n-butylbromide (Buscopan) During Gastrointestinal Endoscopy. J Can Assoc Gastroenterology 2021; 4: 259-268
    CrossrefPubMedGoogle Scholar
  • 8 Lee TJ, Rees CJ, Blanks RG. et al. Colonoscopic factors associated with adenoma detection in a national colorectal cancer screening program.. Endoscopy 2014; 80: 1103-1112.e2
    PubMedGoogle Scholar
  • 9 Rondonotti E, Zolk O, Amato A. et al. The impact of hyoscine-N-butylbromide on adenoma detection during colonoscopy: meta-analysis of randomized, controlled studies.. Gastrointest Endosc 2014; 80: 1103-1112.e2
    CrossrefPubMedGoogle Scholar
  • 10 Khan MY, Dirweesh A, Siddiqui WJ. Impact of hyoscine bromide use on polyp detection rate during colonoscopy: a systematic review and meta-analysis. Gastroenterology Res 2018; 11: 295-304 DOI: 10.14740/gr1057w. (PMID: 30116429)
    CrossrefPubMedGoogle Scholar
  • 11 Cui PJ, Yao J, Han HZ. et al. Does hyoscine butylbromide really improve polyp detection during colonoscopy? A meta-analysis of randomized controlled trials. World J Gastroenterology 2014; 20: 7034-7039
    CrossrefPubMedGoogle Scholar
  • 12 Hureibi K, Abraham P, Alsunidar O. et al. Does hyoscine improve polyp detection rate during colonoscopy? systematic review & meta-analysis of randomized clinical trials. Annals Med Surg 2018; 36: 41-46
    CrossrefPubMedGoogle Scholar
  • 13 Katsinelos P, Lazaraki G, Chatzimavroudis G. et al. Impact of nitroglycerin and glucagon administration on selective common bile duct cannulation and prevention of post-ERCP pancreatitis. Scand J Gastroenterol 2017; 52: 50-55 DOI: 10.1080/00365521.2016.1228117. (PMID: 27690682)
    CrossrefPubMedGoogle Scholar
  • 14 Lahoti S, Catalano MF, Geenen JE. et al. A prospective, double-blind trial of L-hyoscyamine versus glucagon for the inhibition of small intestinal motility during ERCP. Gastrointest Endosc 1997; 46: 130-142
    CrossrefPubMedGoogle Scholar
  • 15 Chang FY, Guo WS, Liao TM. et al. A randomized study comparing glucagon and hyoscine N-butyl bromide before endoscopic retrograde cholangiopancreatography. Scand J Gastroenterol 1995; 30: 283-286
    CrossrefPubMedGoogle Scholar
  • 16 Denzer U, Beilenhoff U, Eickhoff A. et al. S2k guideline: quality requirements for gastrointestinal endoscopy, AWMF registry no. 021–022. Z Gastroenterol 2015; 53: E1-E227 DOI: 10.1055/s-0041-109598. (PMID: 26783975)
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 2004; 6: e34 DOI: 10.2196/jmir.6.3.e34. (PMID: 15471760)
    CrossrefPubMedGoogle Scholar
  • 18 Bedford MR, Reuser T, Wilson P. et al. Administration of hyoscine n-butylbromide during colonoscopy: a survey of current UK practice. Frontline Gastroenterol 2012; 3: 238-241
    CrossrefPubMedGoogle Scholar
  • 19 Zhang L, Song J, Bai T. et al. Effects of Buscopan on human gastrointestinal smooth muscle activity in an ex vivo model: Are there any differences for various sections?. Eur J Pharmacol 2016; 780: 180-187
    CrossrefPubMedGoogle Scholar
  • 20 Omata F, Kumakura Y, Ishii N. et al. Noneffectiveness of scopolamine for facilitating detection of upper gastrointestinal neoplasia during screening esophagogastroduodenoscopy: propensity score-matched study. Endoscopy 2020; 52: 556-562
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Rondonotti E, Radaelli F, Paggi S. et al. Hyoscine N-butylbromide for adenoma detection during colonoscopy: a randomized, double-blind, placebo-controlled study. Digestive and Liver Disease 2013; 45: 663-668
    CrossrefPubMedGoogle Scholar
  • 22 de Brouwer EJ, Arbouw Me, van der Zwet WC. et al. Hyoscine N-butylbromide does not improve polyp detection during colonoscopy: a double-blind, randomized, placebo-controlled, clinical trial. Gastrointest Endosc 2012; 75: 835-840
    CrossrefPubMedGoogle Scholar
  • 23 Yoong KY, Perkin D, Portal J. et al. Intravenous hyoscine as a premedication for colonoscopy: a randomized double-blind controlled trial. Endoscopy 2004; 36: 720-722 DOI: 10.1055/s-2004-825660. (PMID: 15280979)
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Madhoun MF, Ali T, Tierney WM. et al. Effect of hyoscine N-butylbromide on adenoma detection rate: meta-analysis of randomized clinical trials. Digest Endosc 2015; 27: 354-360 DOI: 10.1111/den.12340. (PMID: 25115416)
    CrossrefPubMedGoogle Scholar
  • 25 Corte C, Dahlenburg L, Selby W. et al. Hyoscine butylbromide administered at the cecum increases polyp detection: a randomized double-blind placebo-controlled trial. Endoscopy 2012; 44: 917-922 DOI: 10.1055/s-0032-1310009. (PMID: 22893135)
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Kim EJ, Um MY, Kim KO. et al. Safety and efficacy of glycopyrrolate as a premedication for endoscopic submucosal dissection: a randomized, double-blind, placebo-controlled study. Endoscopy 2017; 49: 949-956
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Chiu PA-OX, Uedo N, Singh R. et al. An Asian consensus on standards of diagnostic upper endoscopy for neoplasia. Gut 2019; 68: 186-197
    CrossrefPubMedGoogle Scholar
  • 28 Sano YA-O, Chiu HM, Li XB. et al. Standards of diagnostic colonoscopy for early-stage neoplasia: Recommendations by an Asian private group. Digest Endosc 2019; 31: 227-244
    CrossrefPubMedGoogle Scholar
  • 29 Hannigan BF, Axon AT, Avery S. et al. Buscopan or glucagon for endoscopic cannulation of ampulla of vater?. J R Soc Med 1982; 75: 21-22 DOI: 10.1177/014107688207500106. (PMID: 6173480)
    CrossrefPubMedGoogle Scholar
  • 30 Yamamoto N, Nakai Y, Sasahira N. et al. Efficacy of peppermint oil as an antispasmodic during endoscopic retrograde cholangiopancreatography. J Gastroenterol Hepatol 2006; 21: 1394-1398
    CrossrefPubMedGoogle Scholar
  • 31 Bowles CJ, Leicester R, Romaya C. et al. A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?. Gut 2004; 53: 277-283 DOI: 10.1136/gut.2003.016436. (PMID: 14724164)
    CrossrefPubMedGoogle Scholar
  • 32 Fink AM, Aylward GW. Buscopan and glaucoma: a survey of current practice. Clin Radiol 1995; 50: 160-164 DOI: 10.1016/s0009-9260(05)83047-8. (PMID: 7889705)
    CrossrefPubMedGoogle Scholar
  • 33 Froehlich JM, Daenzer M, von Weymarn C. et al. Aperistaltic effect of hyoscine N-butylbromide versus glucagon on the small bowel assessed by magnetic resonance imaging. Europ Radiol 2009; 19: 1387-1393
    CrossrefPubMedGoogle Scholar
  • 34 Hashimoto T, Adachi K, Ishimura N. et al. Safety and efficacy of glucagon as a premedication for upper gastrointestinal endoscopy--a comparative study with butyl scopolamine bromide. Aliment Pharmacol Ther 2002; 16: 111-118
    CrossrefPubMedGoogle Scholar
  • 35 Imagawa A, Hata H, Nakatsu M. et al. Peppermint oil solution is useful as an antispasmodic drug for esophagogastroduodenoscopy, especially for elderly patients. Dig Dis Sci 2012; 57: 2379-2384
    CrossrefPubMedGoogle Scholar