Sanagapalli Santosh, Agnihotri Kriti, Leong Rupert, Corte Crispin John
Gastroenterology & Liver Services, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW 2139, Australia.
Gastroenterology & Liver Services, Concord Repatriation General Hospital, Sydney, NSW, Australia.
Therap Adv Gastroenterol. 2017 Jan;10(1):101-113. doi: 10.1177/1756283X16670076. Epub 2016 Oct 3.
Antispasmodic drugs are cheap, effective and generally safe. They may improve outcomes in colonoscopy, however their use has not been consistent or widespread. This manuscript reviews the three most commonly used antispasmodics in colonoscopy, namely, hyoscine butylbromide (and related ammonium compounds), glucagon and peppermint oil. The pharmacology, action and safety of the agents, as well as the evidence for them improving colonoscopic outcomes will be discussed. In addition to polyp detection, other colonoscopic outcome endpoints of interest include cecal and ileal intubation, and patient comfort. The drugs studied were all found to be effective gastrointestinal antispasmodics with good safety profiles. There is insufficient evidence to conclude whether antispasmodics improve cecal intubation rate, predominantly because the baseline rates are already high. Antispasmodics probably have efficacy in reducing cecal intubation time especially in those with marked colonic spasm. Antispasmodics do not offer significant benefit in polyp detection or improving patient comfort during colonoscopy. Future studies should focus on inexperienced colonoscopists as well as those with marked colonic spasm, in whom the greatest benefit seems to lie.
抗痉挛药物价格便宜、效果显著且总体安全。它们可能会改善结肠镜检查的结果，然而其使用并不一致或广泛。本手稿综述了结肠镜检查中最常用的三种抗痉挛药物，即丁溴东莨菪碱（及相关铵化合物）、胰高血糖素和薄荷油。将讨论这些药物的药理学、作用和安全性，以及它们改善结肠镜检查结果的证据。除息肉检测外，其他感兴趣的结肠镜检查结果终点包括盲肠和回肠插管以及患者舒适度。研究发现，所研究的药物均为有效的胃肠道抗痉挛药物，安全性良好。没有足够的证据来断定抗痉挛药物是否能提高盲肠插管率，主要是因为基线率已经很高。抗痉挛药物可能在缩短盲肠插管时间方面有效，尤其是在那些有明显结肠痉挛的患者中。抗痉挛药物在息肉检测或改善结肠镜检查期间患者舒适度方面并无显著益处。未来的研究应聚焦于经验不足的结肠镜检查医师以及那些有明显结肠痉挛的患者，他们似乎能从中获得最大益处。
