Journal Article On-Demand Use of L-menthol May Substitute for the Routine Use of Anti-Peristaltic Drugs in Esophagogastroduodenoscopy

Onochi, Kengo  ,  Gotoda, Takuji  ,  Mashima, Hirosato  ,  Kusano, Chika  ,  Iijima, Katsunori

43 ( 3/4 )  , pp.99 - 104 , 2017-03-31 , 秋田医学会
Background : In Japan, anti-peristaltic drugs are routinely injected as a countermeasure to control the occurrence of spasms during esophagogastroduodenoscopy (EGD). However, few reports have so far shown these drugs to improve the quality of diagnostic EGD. We evaluated the requirement of anti-peristaltic premedication and the efficacy of the selective use of L-menthol. Methods : 173 patients who underwent EGD screening were enrolled prospectively. Endoscopy was performed without the administration of any anti-peristaltic drugs. The degree of gastric peristalsis was assessed when the endoscope reached the antrum. Gastric peristalsis was classified into three grades : none, mild or severe. When gastric peristalsis was severe, 20 mL of 0.8% L-menthol was sprayed endoscopically on the gastric mucosa. Thereafter, we again assessed the grade of peristalsis and measured the time interval until peristalsis was suppressed. Results : The peristaltic grade observed without the use of any anti-peristaltic drugs was none or mild in 88.5% of the patients. After spraying L-menthol, the proportion of subjects with severe peristalsis was 0.0% and EGD screening was performed satisfactorily. Conclusions : The routine use of premedication with anti-peristaltic drugs during EGD screening may not be necessary. When severe peristalsis interferes with precise observation, the use of L-menthol is easy and sufficient.

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