THE USE OF HYOSCINE BUTYLBROMIDE IMPROVES SESSILE SERRATED LESION DETECTION

Aims Sessile serrated lesions (SSL) are significant precursors of the alternative serrated neoplasia pathway. Achieving key performance indicators (KPI) in colonoscopy increases the detection of premalignant lesions. The SSL detection rate (SSLDR) is not currently recognised as a KPI, with no agreed minimal SSLDR. Data on the impact of Hyoscine Butylbromide (HB) on adenoma detection is conflicting. This study aimed to report the SSL detection rate over time and identify factors associated with increasing SSL detection.

Methods A retrospective review of screening colonoscopies from 2015-2021 was performed. Adenoma, hyperplastic polyp (HP) and SSL detection rates (ADR, HPDR, SSLDR) were recorded. High grade dysplasia (HGD) and cancer detection was documented. Quality measures including bowel preparation, patient comfort, sedation rates and use of HB were noted.

Results 4145 screening colonoscopies were reviewed. 2967 (71.6%) had polyps. Male (60.5%), median age 66 years (range 60-78). The detection rates for adenoma, SSL and HP were 56.9%, 10.4% and 23% respectively. The SSLDR increased over the 6-year study period (7.4% to 11.6%, p=0.01) ([Figure 1]), with no significant difference in individual endoscopists’ SSLDR (n=6) (range 9.5%-12.5%, p=0.6). Use of HB ranged from 7.1%-45.6%. ADR (70.6% vs 53.9%, p=<0.01) and SSLDR (15.1% vs. 9.4%, p=<0.01) were greater with the use of HB. Bowel preparation did not impact the SSLDR (p=0.15). SSL detection was associated with a higher HGD detection (5.1% vs. 3.1%, p=0.028), but not cancer (3.3% vs. 3.2%, p=0.98).

Fig. 1

Conclusions SSL detection rates are increasing with associated greater HGD detection. SSL detection was enhanced with the use of HB.

Publication History

Article published online:
14 April 2022