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Ullmann O, Ranti D, Georgiadou E, Hillemacher T, Schmidt A, von Hahn T. Provider-reported use of butylscopolamine in gastrointestinal endoscopy in Germany. Endosc Int Open 2024; 12:E36-E42. [PMID: 38188926 PMCID: PMC10769577 DOI: 10.1055/a-2189-0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/14/2023] [Indexed: 01/09/2024] Open
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.
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Affiliation(s)
- Octavia Ullmann
- Gastroenterology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Daniel Ranti
- Institute of Medical Education, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Ekaterini Georgiadou
- Psychiatry and Psychotherapy, Paracelsus Private Medical University - Nuremberg Campus, Nurnberg, Germany
| | - Thomas Hillemacher
- Psychiatry and Psychotherapy, Paracelsus Private Medical University - Nuremberg Campus, Nurnberg, Germany
| | - Arthur Schmidt
- Gastroenterology, Hepatology and Endocrinology, Robert Bosch Hospital, Stuttgart, Germany
| | - Thomas von Hahn
- Gastroenterology, Asklepios Klinik Barmbek, Hamburg, Germany
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Özkara B, Aydemir E, Koşar MN, Mayir B. The effects of the use of hyoscine-N-butylbromide during laparoscopic sleeve gastrectomy. Turk J Surg 2023; 39:89-94. [PMID: 38026911 PMCID: PMC10681101 DOI: 10.47717/turkjsurg.2023.5963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/20/2023] [Indexed: 12/01/2023]
Abstract
Objectives Hyoscine-N-butylbromide is used by some surgeons during laparoscopic sleeve gastrectomy (LSG) to loosen gastric smooth muscles and to provide a more effective LSG. However, evidence-based data on the effects of hyoscine-N-butylbromide in laparoscopic sleeve gastrectomy are limited and its effect on sleeve gastrectomy surgery and weight loss is unknown. The aim of this study was to analyze the effect of intraoperatively administered hyoscine-N-butylbromide on stomach resection volume, weight loss and complications seen in patients undergoing LSG. Material and Methods Patients who underwent laparoscopic sleeve gastrectomy due to morbid obesity were included in the study. Intraoperative hyoscine-N-butylbromide was administered to 52 patients (Group 1), not applied to the other 52 patients (Group 2). Age, sex, height, weight and body mass index (BMI) data of the patients were obtained retrospectively. The weight, BMI, percentage of total weight loss (TWL%) and percentage of excess weight loss (EWL%) of the patients were evaluated at postoperative third, sixth and 12th months. Results Resected gastric volume (p= 0.111), length of stapler line (p= 0.944), operation time (p= 0.383), hospitalization time (p= 0.494) and postoperative complications (p> 0.05) did not differ between Groups 1 and 2. However, frequency of intraoperative tachycardia (p <0.001) and hypotension (p= 0.006) in Group 1 was significantly higher than in Group 2. TWL% and EWL% values were similar between the two groups at all-time points. Stapler line leakage was not observed in any patient during the postoperative period. Conclusion Intraoperative hyoscine-N-butylbromide use is not effective on weight loss postoperatively in patients undergoing LSG. Although hypotension and tachycardia occured in some of patients, none of the patients had complaints in the early or long-term postoperative period. The use of hyoscine-N-butylbromide during LSG is safe but does not have any effect on weight loss.
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Affiliation(s)
- Barış Özkara
- Clinic of General Surgery, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Erhan Aydemir
- Clinic of General Surgery, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Mehmet Nuri Koşar
- Clinic of General Surgery, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Burhan Mayir
- Clinic of General Surgery, Antalya Training and Research Hospital, Antalya, Türkiye
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Keating E, Leyden J, O'Connor DB, Lahiff C. Unlocking quality in endoscopic mucosal resection. World J Gastrointest Endosc 2023; 15:338-353. [PMID: 37274555 PMCID: PMC10236981 DOI: 10.4253/wjge.v15.i5.338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
A review of the development of the key performance metrics of endoscopic mucosal resection (EMR), learning from the experience of the establishment of widespread colonoscopy quality measurements. Potential future performance markers for both colonoscopy and EMR are also evaluated to ensure continued high quality performance is maintained with a focus service framework and predictors of patient outcome.
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Affiliation(s)
- Eoin Keating
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jan Leyden
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Donal B O'Connor
- Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Conor Lahiff
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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4
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Forbes N, Frehlich L, Borgaonkar M, Leontiadis GI, Tse F. Canadian Association of Gastroenterology (CAG) Position Statement on the Use of Hyoscine- n-butylbromide (Buscopan) During Gastrointestinal Endoscopy. J Can Assoc Gastroenterol 2021; 4:259-268. [PMID: 34877465 PMCID: PMC8643672 DOI: 10.1093/jcag/gwab038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/23/2021] [Indexed: 12/21/2022] Open
Abstract
Hyoscine butylbromide, also known as hyoscyamine or scopolamine, and sold under the trade name Buscopan, is an antimuscarinic agent commonly used to induce smooth muscle relaxation and reduce spasmodic activity of the gastrointestinal (GI) tract during endoscopic procedures. However, the balance between desirable and undesirable (adverse) effects is not clear when used during GI endoscopy. The Clinical Affairs Committee of the Canadian Association of Gastroenterology (CAG) conducted systematic reviews and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations for the use of Buscopan during GI endoscopy. To summarize, we recommend against the use of Buscopan before or during colonoscopy (strong recommendation, high certainty of evidence). We suggest against the use of Buscopan before or during gastroscopy (conditional recommendation, very low certainty of evidence). We suggest the use of Buscopan before or during ERCP (conditional recommendation, very low certainty of evidence). More research is needed to determine whether patients undergoing advanced procedures such as endoscopic mucosal resection or endoscopic submucosal dissection benefit from its use. Buscopan should be used with caution in patients with cardiac comorbidities. According to its product monograph, Buscopan is contraindicated in patients with tachycardia, angina, and cardiac failure. Thus, Buscopan should be used very cautiously in patients with these conditions, and only when the potential benefits of its use outweigh the potential risks in a particular case. Such patients require careful cardiac monitoring in an environment where resuscitation equipment and appropriately trained staff to use it are readily available. According to its product monograph, Buscopan is also contraindicated in patients with prostatic hypertrophy with urinary retention, and therefore, should be used very cautiously in such patients as well, and only when the potential benefits of its use outweigh the potential risks in a particular case. Obtaining a preprocedural history of glaucoma is unlikely to be of value when considering Buscopan use. However, in cases where Buscopan has been used, patients should be counselled postprocedurally and told to present to an emergency facility should they experience eye pain, redness, decreased vision, nausea and vomiting or headache.
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Affiliation(s)
- Nauzer Forbes
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Levi Frehlich
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mark Borgaonkar
- Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Grigorios I Leontiadis
- Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada.,Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Frances Tse
- Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada.,Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Lee T, Anderson J, Thomas-Gibson S, Rees C. Use of intravenous hyoscine butylbromide (Buscopan) during gastrointestinal endoscopy. Frontline Gastroenterol 2018; 9:183-184. [PMID: 30046421 PMCID: PMC6056080 DOI: 10.1136/flgastro-2017-100877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Thomas Lee
- Gastroenterology, Northumbria Healthcare NHS Foundation Trust, UK,Northern Region Endoscopy Group (NREG), Newcastle, UK
| | - John Anderson
- Department of Gastroenterology, Cheltenham General Hospital, Cheltenham, UK,Bowel Cancer Screening Programme Accreditation Panel, London, UK
| | - Siwan Thomas-Gibson
- Wolfson Unit for Endoscopy, St Mark’s Hospital, London, UK,Surgery, Imperial College, London, UK,Joint Advisory Group (on Gastrointestinal Endoscopy), London, UK
| | - Colin Rees
- Northern Region Endoscopy Group (NREG), Newcastle, UK,Department of Gastroenterology, South Tyneside General Hospital, South Shields, UK,British Society of Gastroenterology, London, UK,Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
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Willson ML, Vernooij RWM, Gagliardi AR. Questionnaires used to assess barriers of clinical guideline use among physicians are not comprehensive, reliable, or valid: a scoping review. J Clin Epidemiol 2017; 86:25-38. [PMID: 28104462 DOI: 10.1016/j.jclinepi.2016.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/27/2016] [Accepted: 12/23/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study described the number and characteristics of questionnaires used to assess barriers of guideline use among physicians. STUDY DESIGN AND SETTING A scoping review was conducted. MEDLINE and EMBASE were searched from 2005 to June 2016. English-language studies that administered a questionnaire to assess barriers of guideline use among practicing physicians were eligible. Summary statistics were used to report study and questionnaire characteristics. Questionnaire content was assessed with a checklist of 57 known barriers. RESULTS Each of the 178 included studies administered a unique questionnaire. The number of questionnaires increased yearly from 2005 to 2015. Few were pilot-tested (50, 28.1%) or tested for psychometric properties (3, 1.7%). Two were based on theory. None probed for the full range of known barriers. Ten included a free-text option. The majority assessed professional barriers (177, 99.4%) but few of the 14 factors within this domain. Questionnaire characteristics did not change over time. CONCLUSION Organizations administered questionnaires that were not reliable or valid and did not comprehensively assess barriers and may have selected interventions unlikely to promote guideline use. Research is needed to construct a questionnaire that is practical, adaptable, and robust and leads to the selection of interventions that support guideline use.
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Affiliation(s)
- Melina L Willson
- Systematic Reviews & Health Technology Assessments, NHMRC Clinical Trials Centre, University of Sydney, K25 - Medical Foundation Building, Sydney, NSW 2006, Australia
| | - Robin W M Vernooij
- Institute of Biomedical Research (IIB Sant Pau), Iberoamerican Cochrane Centre, Pavelló 18 Planta 0, 08025, Barcelona, Spain
| | - Anna R Gagliardi
- Toronto General Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G2C4, Canada.
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Dolwani S. Surveying and understanding colonoscopy technique. Frontline Gastroenterol 2012; 3:218-219. [PMID: 28839670 PMCID: PMC5369828 DOI: 10.1136/flgastro-2012-100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2012] [Indexed: 02/04/2023] Open
Affiliation(s)
- Sunil Dolwani
- Department of Gastroenterology, University Hospital Llandough, Cardiff, UK
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