Meta-Analysis
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World J Gastrointest Endosc. Nov 16, 2014; 6(11): 549-554
Published online Nov 16, 2014. doi: 10.4253/wjge.v6.i11.549
Hyoscine for polyp detection during colonoscopy: A meta-analysis and systematic review
Imran Ashraf, Sohail Ashraf, Sameer Siddique, Douglas L Nguyen, Abhishek Choudhary, Matthew L Bechtold
Imran Ashraf, Sameer Siddique, Abhishek Choudhary, Matthew L Bechtold, Department of Medicine, University of Missouri, Columbia, MO 65212, United States
Sohail Ashraf, Department of Gastroenterology and Hepatology, Central Manchester University Hospitals, M139WL Manchester, United Kingdom
Douglas L Nguyen, Department of Medicine, University of California, Irvine, CA 92868, United States
Author contributions: Ashraf I, Choudhary A and Bechtold ML contributed equally to this work; Ashraf I, Ashraf S and Bechtold ML designed the research; Ashraf I, Ashraf S and Siddique S performed the research; Nguyen DL, Choudhary A and Bechtold ML analyzed the data; Ashraf I, Ashraf S and Siddique S wrote the paper; Nguyen DL, Choudhary A and Bechtold ML revised the manuscript.
Correspondence to: Matthew L Bechtold, MD, FASGE, FACG, Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, Five Hospital Drive, Columbia, MO 65212, United States. bechtoldm@health.missouri.edu
Telephone: +1-573-8821013 Fax: +1-573-8844595
Received: May 6, 2014
Revised: September 10, 2014
Accepted: October 1, 2014
Published online: November 16, 2014
Abstract

AIM: To assess the role of hyoscine for polyp detection during colonoscopy.

METHODS: Studies (randomized controlled trials or RCTs) that compared the use of hyoscine vs no hyoscine or placebo for polyp detection during colonoscopy were included in our analysis. A search on multiple databases was performed in September 2013 with search terms being “hyoscine and colonoscopy”, “hyoscine and polyp”, “hyoscine and adenoma”, “antispasmotic and colonoscopy”, “antispasmotic and adenoma”, and “antispasmotic and polyp”. Jadad scoring was used to assess the quality of studies. The efficacy of hyoscine was analyzed using Mantel-Haenszel model for polyp and adenoma detection with odds ratio (OR). The I2 measure of inconsistency was used to assess heterogeneity (P < 0.05 or I2 > 50%). Statistical analysis was performed by RevMan 5.1. Funnel plots was used to assess publication bias.

RESULTS: The search of the electronic databases identified 283 articles. Of these articles, eight published RCTs performed at various locations in Europe, Asia, and Australia were included in our meta-analysis, seven published as manuscripts and one published as an abstract (n = 2307). All the studies included patients with a hyoscine and a no hyoscine/placebo group and were of adequate quality (Jadad score ≥ 2). Eight RCTs assessed the polyp detection rate (PDR) (n = 2307). The use of hyoscine demonstrated no statistically significant difference as compared to no hyoscine or placebo for PDR (OR = 1.06; 95%CI: 0.89-1.25; P = 0.51). Five RCTs assessed the adenoma detection rate (ADR) (n = 2015). The use of hyoscine demonstrated no statistically significant difference as compared to no hyoscine or placebo for ADR (OR = 1.12; 95%CI: 0.92-1.37; P = 0.25). Furthermore, the timing of hyoscine administration (given at cecal intubation or pre-procedure) demonstrated no differences in PDR compared to no hyoscine or placebo. Publication bias or heterogeneity was not observed for any of the outcomes.

CONCLUSION: Hyoscine use in patients undergoing colonoscopy does not appear to significantly increase the detection of polyps or adenomas.

Keywords: Hyoscine, Antispasmodic, Polyp detection, Colonoscopy

Core tip: Hyoscine is used in clinical practice to decrease spasms in the colon during colonoscopy in an effort to improve polyp or adenoma detection. However, this study shows that hyoscine given before the procedure or at time of cecal intubation does not improve polyp or adenoma detection.