L-menthol improves adenoma detection rate during colonoscopy: a randomized trial

Ken Inoue; Osamu Dohi; Yasuyuki Gen; Masayasu Jo; Takeshi Mazaki; Kazuhiko Tokita; Naohisa Yoshida; Tetsuya Okayama; Kazuhiro Kamada; Kazuhiro Katada; Kazuhiko Uchiyama; Takeshi Ishikawa; Osamu Handa; Tomohisa Takagi; Hideyuki Konishi; Naoki Wakabayashi; Nobuaki Yagi; Yuji Naito; Yoshito Itoh

doi:10.1055/s-0034-1365035

Endoscopy, Table of Contents

Endoscopy 2014; 46(03): 196-202
DOI: 10.1055/s-0034-1365035

Original article

L-menthol improves adenoma detection rate during colonoscopy: a randomized trial

Authors

Ken Inoue

¹Department of Molecular Gastroenterology and Hepatology, North Medical Center Kyoto Prefectural University of Medicine, Kyoto, Japan

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Osamu Dohi

¹Department of Molecular Gastroenterology and Hepatology, North Medical Center Kyoto Prefectural University of Medicine, Kyoto, Japan

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Yasuyuki Gen

¹Department of Molecular Gastroenterology and Hepatology, North Medical Center Kyoto Prefectural University of Medicine, Kyoto, Japan

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Masayasu Jo

¹Department of Molecular Gastroenterology and Hepatology, North Medical Center Kyoto Prefectural University of Medicine, Kyoto, Japan

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Takeshi Mazaki

³Department of Surgical Pathology, North Medical Center Kyoto Prefectural University of Medicine, Kyoto, Japan
Kazuhiko Tokita

¹Department of Molecular Gastroenterology and Hepatology, North Medical Center Kyoto Prefectural University of Medicine, Kyoto, Japan
Naohisa Yoshida

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Tetsuya Okayama

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Kazuhiro Kamada

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Kazuhiro Katada

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Kazuhiko Uchiyama

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Takeshi Ishikawa

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Osamu Handa

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Tomohisa Takagi

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Hideyuki Konishi

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Naoki Wakabayashi

⁴Department of Gastroenterology, Otsu City Hospital, Shiga, Japan
Nobuaki Yagi

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Yuji Naito

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Yoshito Itoh

²Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan

Abstract

Background and study aims: Colonoscopy is one of the most reliable methods for the detection of colorectal neoplasms. However, colonic peristalsis during colonoscopy results in some neoplastic lesions being hidden from view and commonly requires an intravenous or intramuscular injection of antispasmodic agents, which may sometimes causes unexpected adverse reactions. The aim of this study was to evaluate the efficacy of L-menthol spray as an antiperistaltic agent and its effect on adenoma detection.

Patients and methods: This was a prospective, randomized, single-blind placebo-controlled trial. A total of 226 patients who were scheduled to undergo colonoscopy were randomly assigned to receive either 20 mL of 1.6 % L-menthol (n = 118) or placebo (n = 108). Both treatments were sprayed locally onto the colonic mucosa via an endoscope. The adenoma detection rate (ADR) and the proportion of patients with no peristalsis were the primary and secondary outcomes, respectively.

Results: The ADR was significantly higher in the L-menthol group than in the placebo group (60.2 % vs. 42.6 %; P = 0.0083). The proportion of patients with no peristalsis after treatment with L-menthol was significantly higher than in the placebo group (71.2 % vs. 30.9 %; P < 0.0001). There were no adverse effects in either group.

Conclusions: The results suggest that the suppression of colonic peristalsis by L-menthol sprayed directly onto the colonic mucosa improves the ADR.

Clinical trial registration: ID: UMIN 000007972.

Full Text

References

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