Why use Buscopan during diagnostic upper gastrointestinal endoscopy?

Why use Buscopan during diagnostic upper gastrointestinal endoscopy? EDITOR,-In their audit of upper gastro-intestinal endoscopy (Gut 1995; 36: 462-7), Quine et al considered the issues surrounding the use of anticholinergic agents during upper gastrointestinal endoscopy. They found that although most procedures were performed without the use of either hyoscine butyl-bromide (Buscopan, Boehringer Ingleheim) or atropine these agents were still in use in certain centres and their findings indicate that Buscopan (dose range 10-40 mg) was used in 29% of procedures in East Anglia compared with 20/6% in the North West region and atropine (0-6 mg intravenously) was used in 11-2% procedures in the North West region and only 0.3% in East Anglia. Buscopan is a spasmolytic or smooth muscle relaxant drug with anticholinergic activity. Its anticholinergic activity lasts for about 15-20 minutes and infusion experiments suggest that it is rapidly inactivated or excreted. It also has a sympathetic ganglion blocking action but this effect is unimportant in humans at the conventional dose of 20 mg commonly used. Its actions on the gastro-intestinal tract include inhibition of motility in the stomach and colon, reduction of gastric acid secretion, and slowing transit through the small bowel. It also causes transient pylorospasm. Some studies have shown that oesophageal peristalsis is reduced by Busco-pan' and that it relaxes the lower oesophageal sphincter.2 What is the rationale for the routine use of anticholinergic agents during diagnostic upper gastrointestinal endoscopy? The use of atropine to dry up secretions and for 'cardiac protection' is a benefit postulated3 without there being any controlled data available. Reports have shown that anticholinergic pre-medication does not improve the quality of diagnostic endoscopy or reduce patient discomfort .4 5 These investigators found no differences between groups with respect to gastric motor function or endoscopic quality as judged by the endoscopist or discomfort during endoscopy as judged by the patient.4 Though atropine decreased both the amplitude and frequency of gastric peristalsis this objective effect of atropine did not have any effect on the outcome of the endoscopy.5 Anticholinergic premedication does not have any effect in reducing the incidence of cardiac arrhythmias during upper gastro-intestinal endoscopy.6 The audit by Quine et al reports on a total of eight patients who experienced significant cardiac arrhythmias that required treatment, including five patients who arrested. Four of these had been given Buscopan (two had been given doses of 40 mg). In another prospective study7 comparing the use …