Antiperistaltic effect and safety of L-menthol for esophagogastroduodenoscopy in the elderly with contraindication to hyoscine-N-butylbromide

Tsung-Chieh Yang, Ping-Hsien Chen, Ming-Chih Hou, Li-Ning Peng, Ming-Hsien Lin, Liang-Kung Chen, Yi-Hsiang Huang, Tsung-Chieh Yang, Ping-Hsien Chen, Ming-Chih Hou, Li-Ning Peng, Ming-Hsien Lin, Liang-Kung Chen, Yi-Hsiang Huang

Abstract

Hyoscine-N-butylbromide (HBB) is the most used antiperistaltic agent during esophagogastroduodenoscopy (EGD). However, almost half of the elderly have a contraindication to HBB. We aimed to evaluate L-menthol's antiperistaltic effect and safety for EGD in the elderly with contraindication to HBB. This prospective, randomized, double-blind, placebo-controlled study screened 86 elderly patients (≥ 65 years old) scheduled to undergo EGD, and 52 of them with contraindication to HBB were enrolled. The participants were randomized to receive L-menthol (n = 26) or a placebo (n = 26), which was locally sprayed on the gastric antrum endoscopically. The proportion of patients with no or mild peristalsis after medication and at the end of EGD was significantly higher in the L-menthol group (76.9%) than in the placebo group (11.5%, p < 0.001). L-Menthol administration significantly reduced peristaltic grade, improved contraction parameters, and eased intragastric examination relative to the placebo (p < 0.001, respectively). Hemodynamic changes, adverse events, and discomfort levels of patients were similar between the two groups. L-Menthol is an effective and safe alternative antiperistaltic medication for EGD in elderly patients with contraindication to HBB. Further large, randomized trials are required to clarify whether L-menthol can lead to better detection yield in the elderly.Clinical trial registration: The study was registered at ClinicalTrials.gov (NCT04593836).

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Figure 1
Figure 1
Schematic diagram of gastric peristalsis evaluation. Video images were recorded for three time periods: before medication (for 60 s), after medication (from 60 to 120 s after spraying the investigational drug), and at the end of esophagogastroduodenoscopy (for 60 s). The onset time of antiperistaltic effect was evaluated from 0 to 60 s after spraying the investigational drug.
Figure 2
Figure 2
Evaluation of gastric peristalsis and ease of intragastric examination.
Figure 3
Figure 3
The Consolidated Standards of Reporting Trials (CONSORT) flow diagram of the study.
Figure 4
Figure 4
The proportion of patients with no (grade 1) or mild (grade 2) peristalsis after medication and at the end of EGD with l-menthol or placebo sprayed on the gastric mucosa. *p < 0.001. EGD esophagogastroduodenoscopy.
Figure 5
Figure 5
The representative endoscopic images before (a) and 1 min after spraying l-menthol (b).

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Source: PubMed

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