Improvement of Quality of Nonanesthetic Colonoscopy by Preoperative Administration of Pinaverium Bromide

Background： Nonanesthetic colonoscopy is popular in clinical practice in China. However, intestinal spasms often result in a prolonged examination time, increased operating difficulties, decreased polyp detection rate, and failure to complete the procedure clinically. Therefore, exploring alternative approaches that can reduce the pain in patients during colonoscopy is of utmost importance, and finding the optimal preoperative administration to improve the quality of nonanesthetic colonoscopy is also necessary. This study aimed to investigate the effects of the prophylactic administration of pinaverium bromide before colonoscopy and the effects of pinaverium bromide alone at different time points or combined with scopolamine butylbromide. Methods： A randomized controlled trial was performed on a cohort of 1000 patients who underwent colonoscopy in outpatient clinic of Wuhan Union Hospital. The patients were randomly assigned to the following groups： Group A, given oral pinaverium bromide （100 mg, three times a day） one day before examination combined with intramuscular injection of scopolamine butylbromide （20 mg） 10 min before colonoscopy; Group B0, given pinaverium bromide alone on the day ofcolonoscopy （ 100 mg, three times a day）; Group B1, given pinaverium bromide alone （100 mg, three times a day） one day before colonoscopy; Group B2, given pinaverium bromide alone （100 mg, three times a day） two days before colonoscopy; and Group C, given scopolamine butylbromide alone （20 mg） before colonoscopy. The successful rate of colonoscopy, procedure time, degree of abdominal pain, and polyp detection rate were recorded and compared among all groups. Results： The successful rate of colonoscopy in Group B1 （82.0%） and Group B2 （83.0%） was significantly higher than that in Group B1 （62.0%, all P 〈 0.01 ）. The time to reach the ileocecal region in Group B1 and Group B, were lower than those in Group B0 （all P 〈 0.05）. However, no significant differences were observed in polyp detection rate between Group B1（24.0%） or Group B2 （26.0%）, and Group Bo （22.4%, all P 〉 0.05）. Furthermore, there were no significant differences in the various parameters examined between Group B1 and Group B2 （P 〉 0.05）. The successful rate of colonoscopy in Group A （92.0%） was significantly higher than that in Group B2 （82.0%） and Group C （80.0%; both P 〈 0.05）. Moreover, the time for the colonoscope to reach the ileocecal region in Group A were markedly shorter as compared to those in Group B1 and Group C （P 〈 0.05）. The polyp detection rate in Group A was 32.0%, significantly higher than that in Group B1 （24.0%, P 〈 0.05） and Group C （24.2%, P 〈 0.05）. Conclusion： Administration of pinaverium bromide alone one day before examination was beneficial to relieve symptoms of abdominal pain during nonanesthetic colonoscopy. In addition, therapeutic effects were improved when pinaverium bromide administration was combined with intramuscular injection of scopolamine butylbromide. Therefore, the combined use ofpinaverium bromide with scopolamine butylbromide might have great application value to improve the quality of nonanesthetic colonoscopy in the preoperative preparation.

Effects of electroacupuncture at Zusanli (ST 36) on neurons in the colonic myenteric plexus in rats with irritable bowel syndrome with constipation

We studied the effects of electroacupuncture at Zusanli （ST 36） on neurons in the colonic myenteric plexus and on defecation in rats with irritable bowel syndrome with constipation （IBS-C）. We also used intragastric administration of pinaverium bromide as a positive control treatment to reveal the pathway mediating the onset of IBS-C. Both electroacupuncture and pinaverium bromide greatly improved defecation in rats with IBS-C. Immunohistochemical staining of the enteric nervous system neuronal marker protein gene product 9.5 in the colonic myenteric plexus showed that electroacupuncture by itself, or in combination with pinaverium bromide, increased the number of neurons and the staining intensity of protein gene product 9.5 in the colonic myenteric plexus. We conclude that visceral hypersensitivity is likely to be a primary cause of constipation in IBS-C rats.