Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 11, Number 4, August 2018, pages 295-304

Impact of Hyoscine Bromide Use on Polyp Detection Rate During Colonoscopy: A Systematic Review and Meta-Analysis

Figure 1. Showing the PRISMA 2009 study flow diagram. PRISMA: preferred reporting items for systematic reviews and meta-analyses; RCT: randomized control trial.

Figure 3. Secondary outcomes: (a) Adenoma detection rate. (b) Advance adenoma detection rate. (c) Mean number of polyps detected.

Figure 4. Secondary outcomes: (a) Cecal intubation time. (b) Polyp location proximal to splenic flexure. (c) Polyp location distal to splenic flexure. (d) Adenomatous polyps.

**Table 1.** Baseline Characteristics of Patients
*Prior abdominal or pelvic surgery. ^aDiverticulosis present or >10. ^bPrior colonoscopy or prior difficult colonoscopy. CRC: colorectal cancer; ABH: altered bowel habits; IBD: irritable bowel disease; NR: not reported; pts: patients.
Studies	Corte et al [6]	Santos et al [7]	Lee et al [8]	Brouwer et al [11]	Ristikankare et al [9]	Byun et al [12]	Rondonotti et al [10]
Journal	Endoscopy	Clinics	Hepato-Gastroenterology	Gastrointestinal Endoscopy	Scandinavian Journal of Gastroenterology	Gastrointestinal Endoscopy	Digestive and Liver Disease
Design	Prospective RCT	Prospective RCT	Prospective RCT	Prospective RCT	Prospective RCT	Prospective RCT	Prospective RCT
Population	Hyoscine	Placebo	Hyoscine	Placebo	Hyoscine	Placebo	Hyoscine	Placebo	Hyoscine	Placebo	Hyoscine	Placebo	Hyoscine	Placebo
Sample size	303	298	220	220	58	58	340	334	75	75	103	102	202	200
Age	60.6 ± 11.2	61.4 ± 10.4	≥ 50 (166 pts), < 50 (54 pts)	≥ 50 (173 pts), < 50 (47 pts)	59.4 ± 8.5	58.4 ± 7.9	61.5	61.4	61.6 ± 8.2	59.8 ± 8.9	NR	NR	57.3 ± 11.5	57.3 ± 13.5
Male no (%)	162 (53.5)	157 (52.7)	73 (33.2)	69 (31.4)	27 (46.6)	23 (39.7)	(45.9)	(52.7)	37	30	NR	NR	90 (44.5)	87 (43.5)
BMI (kg/m²)	NR	NR	NR	NR	NR	NR	NR	NR	26.5 ± 4.5	26.1 ± 4.1	NR	NR	NR	NR
Active smoking	NR	NR	NR	NR	22.4%	17.2%	NR	NR	15%	21%	NR	NR	NR	NR
Prior surgery*	40 (13.4)	40 (13.2)	NR	NR	NR	NR	NR	NR	46	61	NR	NR	NR	NR
Diverticulosis^a	25 (8.3)	19 (6.4)	NR	NR	NR	NR	(31.7)	(34.4)	NR	NR	NR	NR	NR	NR
Prior colonoscopy^b	26 (8.6)	23 (7.7)	NR	NR	NR	NR	NR	NR	(39%)	(36%)	NR	NR	NR	NR
Indication
CRC screening	81 (26.7)	86 (28.9)	NR	NR	58	58	NR	NR	NR	NR	NR	NR	47 (23.2)	53 (26.5)
Polyps surveillance	58 (19.1)	52 (17.4)	NR	NR	0	0	31 (9.1)	30 (9)	(11)	(11)	NR	NR	51 (25.3)	44 (22)
Standard indication	168 (55.4)	164 (55)	NR	NR	0	0	NR	NR	NR	NR	NR	NR	NR	NR
Anemia	NR	NR	NR	NR	0	0	20 (5.9)	15 (4.5)	(21)	(39)	NR	NR	79(39.1)	81 (40.5)
Rectal bleeding	NR	NR	NR	NR	0	0	60 (17.6)	64 (19.2)			NR	NR
Abdominal pain	NR	NR	NR	NR	0	0	55 (16.2)	51 (15.3)	(23)	(11)	NR	NR
Unexplained diarrhea/ABH	NR	NR	NR	NR	0	0	31 (9.1)	34 (10.2)	(21)	(27)	NR	NR
Screening after resection of CRC	NR	NR	NR	NR	0	0	13 (3.8)	16 (4.8)	NR	NR	NR	NR	NR	NR
Family history of CRC	NR	NR	NR	NR	0	0	23 (6.8)	24 (7.2)	NR	NR	NR	NR	25 (12.4)	22 (11)
IBD dysplasia screening	NR	NR	NR	NR	0	0	4 (1.2)	7 (2.1)	NR	NR	NR	NR	NR	NR
Other indication	NR	NR	NR	NR	0	0	NR	NR	(24)	(13)	NR	NR	NR	NR

Table 1. Baseline Characteristics of Patients

*Prior abdominal or pelvic surgery. ^aDiverticulosis present or >10. ^bPrior colonoscopy or prior difficult colonoscopy. CRC: colorectal cancer; ABH: altered bowel habits; IBD: irritable bowel disease; NR: not reported; pts: patients.

Studies

Corte et al [6]

Santos et al [7]

Lee et al [8]

Brouwer et al [11]

Ristikankare et al [9]

Byun et al [12]

Rondonotti et al [10]

Journal

Endoscopy

Clinics

Hepato-Gastroenterology

Gastrointestinal Endoscopy

Scandinavian Journal of Gastroenterology

Gastrointestinal Endoscopy

Digestive and Liver Disease

Design

Prospective RCT

Population

Hyoscine

Placebo

Hyoscine

Placebo

Hyoscine

Placebo

Hyoscine

Placebo

Hyoscine

Placebo

Hyoscine

Placebo

Hyoscine

Placebo

Sample size

303

298

220

340

334

103

102

202

200

Age

60.6 ± 11.2

61.4 ± 10.4

≥ 50 (166 pts), < 50 (54 pts)

≥ 50 (173 pts), < 50 (47 pts)

59.4 ± 8.5

58.4 ± 7.9

61.5

61.4

61.6 ± 8.2

59.8 ± 8.9

57.3 ± 11.5

57.3 ± 13.5

Male no (%)

162 (53.5)

157 (52.7)

73 (33.2)

69 (31.4)

27 (46.6)

23 (39.7)

(45.9)

(52.7)

90 (44.5)

87 (43.5)

BMI (kg/m²)

26.5 ± 4.5

26.1 ± 4.1

Active smoking

22.4%

17.2%

15%

21%

Prior surgery*

40 (13.4)

40 (13.2)

Diverticulosis^a

25 (8.3)

19 (6.4)

(31.7)

(34.4)

Prior colonoscopy^b

26 (8.6)

23 (7.7)

(39%)

(36%)

Indication

CRC screening

81 (26.7)

86 (28.9)

47 (23.2)

53 (26.5)

Polyps surveillance

58 (19.1)

52 (17.4)

31 (9.1)

30 (9)

(11)

51 (25.3)

44 (22)

Standard indication

168 (55.4)

164 (55)

Anemia

20 (5.9)

15 (4.5)

(21)

(39)

79(39.1)

81 (40.5)

Rectal bleeding

60 (17.6)

64 (19.2)

Abdominal pain

55 (16.2)

51 (15.3)

(23)

(11)

Unexplained diarrhea/ABH

31 (9.1)

34 (10.2)

(21)

(27)

Screening after resection of CRC

13 (3.8)

16 (4.8)

Family history of CRC

23 (6.8)

24 (7.2)

25 (12.4)

22 (11)

IBD dysplasia screening

4 (1.2)

7 (2.1)

Other indication

(24)

(13)

**Table 2.** Characteristics of Randomized Controlled Trials
Study	Corte et al [6]	Santos et al [7]	Lee et al [8]	Brouwer et al [11]	Ristikankare et al [9]	Byun et al [12]	Rondonotti et al [10]
Design	Prospective randomized double-blind placebo-controlled trial	Prospective randomized, placebo-controlled trial	Prospective randomized double-blind controlled trial	A prospective, double-blind, placebo-controlled, randomized, clinical trial.	Prospective double-blind, randomized, placebo-controlled, clinical trial	Prospective randomized, double-blinded, placebo-controlled trial	Prospective randomized, double-blind, placebo-controlled trial
Country	Australia	Brazil	Korea	Netherlands	Finland	NR	Italy
Publication year	2012	2017	2010	2012	2015	2009	2013
Journal	Endoscopy	Clinics	Hepato-Gastroenterology	Gastrointestinal Endoscopy	Scandinavian Journal of Gastroenterology	Gastrointestinal Endoscopy	Digestive and Liver Disease
Enrollment	March 2009 to March 2011	March to July 2015	January to June 2008	January 21 to June 21, 2011	March 2012 to March 2014	July 2008 to September 2008	NR
Population	Patients over 40 years old who were scheduled for routine outpatient colonoscopy	CRC screening, surveillance or a clinical suspicion of CRC	Patients between the age 50 and 70 years and had no potential risk factors for CRC	Outpatients aged 30 years or older referred and accepted for colonoscopy	Outpatients scheduled for diagnostic colonoscopy between ages 45 and 75 years	NR	Adult outpatients (18 - 80 years of age) referred for colonoscopy
Intervention vs. comparison	Hyoscine vs. placebo	Hyoscine vs. placebo	Hyoscine vs. placebo	Hyoscine vs. placebo	Hyoscine vs. placebo	Hyoscine vs. placebo	Hyoscine vs. placebo

Table 2. Characteristics of Randomized Controlled Trials

Study

Corte et al [6]

Santos et al [7]

Lee et al [8]

Brouwer et al [11]

Ristikankare et al [9]

Byun et al [12]

Rondonotti et al [10]

Design

Prospective randomized double-blind placebo-controlled trial

Prospective randomized, placebo-controlled trial

Prospective randomized double-blind controlled trial

A prospective, double-blind, placebo-controlled, randomized, clinical trial.

Prospective double-blind, randomized, placebo-controlled, clinical trial

Prospective randomized, double-blinded, placebo-controlled trial

Prospective randomized, double-blind, placebo-controlled trial

Country

Australia

Brazil

Korea

Netherlands

Finland

Italy

Publication year

2012

2017

2010

2012

2015

2009

2013

Journal

Endoscopy

Clinics

Hepato-Gastroenterology

Gastrointestinal Endoscopy

Scandinavian Journal of Gastroenterology

Gastrointestinal Endoscopy

Digestive and Liver Disease

Enrollment

March 2009 to March 2011

March to July 2015

January to June 2008

January 21 to June 21, 2011

March 2012 to March 2014

July 2008 to September 2008

Population

Patients over 40 years old who were scheduled for routine outpatient colonoscopy

CRC screening, surveillance or a clinical suspicion of CRC

Patients between the age 50 and 70 years and had no potential risk factors for CRC

Outpatients aged 30 years or older referred and accepted for colonoscopy

Outpatients scheduled for diagnostic colonoscopy between ages 45 and 75 years

Adult outpatients (18 - 80 years of age) referred for colonoscopy

Intervention vs. comparison

Hyoscine vs. placebo

**Table 3.** Cochrane Risk of Bias
Name	Random sequence	Allocation concealment	Blinding of participants and personnel	Blinding of outcome assessment	Incomplete outcome data	Reporting bias
*Administering nurse not blinded.
Byun et al [12]	Not reported	Not reported	Blinded	Not reported	No	Not reported
	Unclear	Unclear	Low risk	Unclear	Low Risk	Unclear
Lee et al [8]	Central randomization with computer generated codes	Not reported	Blinded (complete)	Not reported	No	Not reported
	Low risk	Unclear	Low risk	Unclear	Low Risk	Unclear
Corte et al [6]	Central randomization with computerized algorithm	No	Single arm blinded*	Not reported	No	Not reported
	Low risk	High risk	Low risk	Unclear	Low risk	Unclear
Brouwer et al [11]	Not reported	Not reported	Not reported	Yes	No	Not reported
	Unclear	Unclear	Unclear	Low risk	Low risk	Unclear
Rondonotti et al [10]	Central randomization using computer generated list	Randomization list	Single arm blinded*	Not reported	No	Not reported
	Low risk	Low risk	Low risk	Unclear	Low risk	Unclear
Ristnikankre et al [9]	Block randomization using sealed envelopes	Sealed and coded envelopes	Blinded (complete)	Not reported	No	Not reported
	Low risk	Low risk	Low risk	Unclear	Low risk	Unclear
Santos et al [7]	Web generated	Sealed envelopes	Blinded	Yes	No	Not reported
	Low risk	Low risk	Low risk	Low risk	Low risk	Unclear

Table 3. Cochrane Risk of Bias

Name

Random sequence

Allocation concealment

Blinding of participants and personnel

Blinding of outcome assessment

Incomplete outcome data

Reporting bias

*Administering nurse not blinded.

Byun et al [12]

Not reported

Blinded

Not reported

Unclear

Low risk

Unclear

Low Risk

Unclear

Lee et al [8]

Central randomization with computer generated codes

Not reported

Blinded (complete)

Not reported

Low risk

Unclear

Low risk

Unclear

Low Risk

Unclear

Corte et al [6]

Central randomization with computerized algorithm

Single arm blinded*

Not reported

Low risk

High risk

Low risk

Unclear

Low risk

Unclear

Brouwer et al [11]

Not reported

Yes

Not reported

Unclear

Low risk

Unclear

Rondonotti et al [10]

Central randomization using computer generated list

Randomization list

Single arm blinded*

Not reported

Low risk

Unclear

Low risk

Unclear

Ristnikankre et al [9]

Block randomization using sealed envelopes

Sealed and coded envelopes

Blinded (complete)

Not reported

Low risk

Unclear

Low risk

Unclear

Santos et al [7]

Web generated

Sealed envelopes

Blinded

Yes

Not reported

Low risk

Unclear