Gergő Dorottya, Tóth-Mészáros Andrea, Schulze Wenning Alexander, Fehérvári Péter, Do To Uyen Nguyen, Hegyi Péter, Erőss Bálint, Ványolós Attila, Csupor Dezső
Department of Pharmacognosy, Semmelweis University, 1085 Budapest, Hungary.
Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary.
J Clin Med. 2025 Jun 17;14(12):4296. doi: 10.3390/jcm14124296.
: Gastrointestinal endoscopy is crucial for diagnosing colorectal cancer and inflammatory bowel diseases, but its effectiveness can be impacted by peristalsis, poor bowel preparation, and inadequate withdrawal time. Conventional antispasmodics, though effective, may not be suitable for elderly patients or those with comorbidities. L-menthol, derived from peppermint oil, has emerged as a safer alternative. Through calcium channel blockade, L-menthol promotes GI smooth muscle relaxation. This study evaluated L-menthol's efficacy and safety as a potential alternative to antispasmodic agents in endoscopy. : Following PRISMA2020 guidelines and the Cochrane Handbook, we conducted a systematic review and meta-analysis of randomized controlled trials involving adults undergoing endoscopy, comparing L-menthol to placebo. The primary outcome was the adenoma detection rate, with secondary outcomes, including severity of peristalsis, safety, withdrawal time, and ease of examination. We searched five databases on 31 May 2023, with updates on 20 October 2024. : Fourteen studies were included. L-menthol reduced peristalsis during colonoscopy and upper endoscopy, achieving a suppression rate of 55.9% (560/1002 patients; odds ratio (OR) = 3.88, 95% confidence interval (95% CI): 2.13-7.07), which improved mucosal visualization. It improved ease of examination (OR = 2.53, 95% CI: 1.35-4.73), allowing endoscopists to perform procedures with less technical difficulty. However, L-menthol had no significant impact on the adenoma detection rate (OR = 1.06, 95% CI: 0.69-1.64), indicating no added benefit for lesion detection, and did not prolong withdrawal time (MD = 3.24 s, 95% CI: -101.05-107.53). Adverse event rates remained low and comparable to placebo (OR = 0.97, 95% CI: 0.74-1.27). : L-menthol reduces peristalsis and enhances ease of examination without adverse events. Although its effect on the adenoma detection rate remains inconclusive, its antispasmodic properties make it a promising alternative for patients who cannot tolerate conventional agents.
胃肠内镜检查对于诊断结直肠癌和炎症性肠病至关重要，但其有效性可能会受到蠕动、肠道准备不佳和退镜时间不足的影响。传统的解痉药虽然有效，但可能不适用于老年患者或患有合并症的患者。源自薄荷油的L-薄荷醇已成为一种更安全的替代品。通过钙通道阻滞，L-薄荷醇可促进胃肠道平滑肌松弛。本研究评估了L-薄荷醇作为内镜检查中解痉剂潜在替代品的疗效和安全性。
遵循PRISMA2020指南和Cochrane手册，我们对涉及接受内镜检查的成年人的随机对照试验进行了系统评价和荟萃分析，将L-薄荷醇与安慰剂进行比较。主要结局是腺瘤检出率，次要结局包括蠕动严重程度、安全性、退镜时间和检查难易程度。我们于2023年5月31日检索了五个数据库，并于2024年10月20日进行了更新。
纳入了14项研究。L-薄荷醇降低了结肠镜检查和上消化道内镜检查期间的蠕动，抑制率达到55.9%（560/1002例患者；优势比（OR）=3.88，95%置信区间（95%CI）：2.13-7.07），这改善了黏膜可视化。它提高了检查的难易程度（OR=2.53，95%CI：1.35-4.73），使内镜医师能够在技术难度较小的情况下进行操作。然而，L-薄荷醇对腺瘤检出率没有显著影响（OR=1.06，95%CI：0.69-1.64），表明对病变检测没有额外益处，并且没有延长退镜时间（平均差（MD）=3.24秒，95%CI：-101.05-107.53）。不良事件发生率仍然较低，与安慰剂相当（OR=0.97，95%CI：0.74-1.27）。
L-薄荷醇可减少蠕动并提高检查的难易程度，且无不良事件。尽管其对腺瘤检出率的影响仍不确定，但其解痉特性使其成为无法耐受传统药物的患者的一个有前景的替代品。
