Intravenous Hyoscine as a Premedication for Colonoscopy: A Randomized Double-Blind Controlled Trial

Background and Study Aims: There is wide variation in the use of antispasmodics to facilitate colonoscopy, both within and between countries, and its use before such procedures remains controversial. The aim of this study was to determine whether there was any objective benefit in using hyoscine as a premedication for colonoscopy in a district general hospital.
Patients and Methods: Consecutive day-case patients undergoing colonoscopy were included in the study. They were prospectively randomly allocated to receive either intravenous hyoscine (n = 61) or intravenous placebo (n = 56) as part of their premedication.
Results: Our analysis demonstrated no statistically significant difference between the two groups with respect to the median time from colonoscope insertion to caecal intubation (9.7 minutes in the hyoscine group vs. 8.3 minutes in the placebo group) or the median total procedure time (14.8 minutes in the hyoscine group vs. 13.8 minutes in the placebo group). There was also no statistically significant difference in success rates for caecal intubation between the two groups (P < 0.06). However a type II error cannot be excluded because of the small sample size.
Conclusion: This study demonstrated no obvious benefit in the routine use of hyoscine as a premedication for colonoscopy in a district general hospital setting.

References

• 1 Bowles C J, Leicester R, Romaya . 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
• 2 Cutler C S, Rex D K, Hawes R H, Lehman G A. Does routine intravenous glucagon administration facilitate colonoscopy? A randomized trial.  Gastrointest Endosc. 1995;  42 346-350
• 3 Bond J H, Chally C H, Blackwood W D. A controlled trial of premedication with dicyclomine hydrochloride (Bentyl) in colonoscopy.  Gastrointest Endosc. 1974;  21 61
• 4 Waxman I, Mathews J, Gallagher J. et al . Limited benefit of atropine as premedication for colonoscopy.  Gastrointest Endosc. 1991;  37 329-331
• 5 Saunders B P, Williams C B. Premedication with intravenous antispasmodic speeds colonoscope insertion.  Gastrointest Endosc. 1996;  43 209-211
• 6 Marshall J B, Patel M, Mahajan R J. et al . Benefit of intravenous antispasmodic (hyoscyamine sulfate) as premedication for colonoscopy.  Gastrointest Endosc. 1999;  49 720-726
• 7 Norfleet R G. Premedication for colonoscopy: randomized, double-blind study of glucagon versus placebo.  Gastrointest Endosc. 1978;  24 164-165
• 8 Saunders B P, Elsby B, Boswell A M. et al . Intravenous antispasmodic and patient-controlled analgesia are of benefit for screening flexible sigmoidoscopy.  Gastrointest Endosc. 1995;  42 123-127
• 9 Shaheen N J, Robertson D J, Crosby M A. et al . Hyoscyamine as a pharmacological adjunct in colonoscopy: a randomized, double-blinded, placebo-controlled trial.  Am J Gastroenterol. 1999;  94 2905-2908
• 10 Dumot J A, Verzola E, Nicol S. et al . Sublingual hyoscyamine for patient comfort during screening sigmoidoscopy: a randomized, double-blind, placebo-controlled clinical trial.  Gastrointest Endosc. 1998;  48 283-286
• 11 Mui L M, Ng E K, Chan K C. et al . Randomized, double-blinded, placebo-controlled trial of intravenously administered hyoscine N-butyl bromide in patients undergoing colonoscopy with patient-controlled sedation.  Gastrointest Endosc. 2004;  59 22-27
• 12 Asao T, Mochiki E, Suzuki H. et al . An easy method for the intraluminal administration of peppermint oil before colonoscopy and its effectiveness in reducing colonic spasm.  Gastrointest Endosc. 2001;  53 172-177
• 13 Church J M. Warm-water irrigation for dealing with spasm during colonoscopy: simple, inexpensive, and effective.  Gastrointest Endosc. 2002;  56 672-674