Aperistaltic effect of hyoscine N-butylbromide versus glucagon on the small bowel assessed by magnetic resonance imaging

Abstract

The aim of this prospective study was to compare the intraindividual aperistaltic effect of 40 mg hyoscine N-butylbromide (HBB/Buscopan) with that of 1 mg glucagon on small bowel motility by using magnetic resonance imaging (MRI). Ten healthy volunteers underwent two separate 1.5-T MRI studies (HBB/glucagon) after a standardized oral preparation with an aqueous solution of Gd-DOTA and ispaghula (Metamucil). A 2D T1-w GRE sequence was acquired (TR 2.7 ms/TE 1.3 ms, temporal resolution 0.25 s) before and after intravenous (i.v.) drug administration and motility was followed over 1 h. On the resulting images the cross-sectional luminal diameters were assessed and plotted over time. Baseline motility frequency, onset of aperistalsis, duration of arrest, reappearance of motility and return to normal motility were analysed. Significant differences regarding reliability and duration of aperistalsis were observed. In the HBB group aperistalsis lasted a mean of 6.8 +/- 5.3 min compared with 18.3 +/- 7 min after glucagon (p < 0.0001). In 50% of cases HBB did not accomplish aperistalsis, whereas glucagon always succeeded (p = 0.05). There were no significant differences in terms of baseline and end frequencies for the onset of aperistalsis (22.2 +/- 37.5 s HBB/13.4 +/- 9.2 s glucagon, p = 0.1), nor for the return to normal motility. Arrest of small bowel motion is achieved more reliably and lasts significantly longer after i.v. administration of 1 mg glucagon compared with 40 mg HBB.

Erratum to: Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign

“…In one European study, 92% of academic radiologists surveyed used a spasmolytic agent, most commonly hyoscine butylbromide (Buscopan Ò , Boehringer-Ingelheim, Ingelheim, Germany) which is an agent approved outside of the USA [12]. In the USA, most centers use glucagon (GlucaGen Ò , Novo Nordisk, DK-2880 Bagsvaerd) [26,32]. However, it is important to note that cine BSSFP sequences should be performed before spasmolytic agents are administered.…”

“…First established with fluoroscopy, small bowel peristalsis can be evaluated with MRE using a cine balanced steady-state free precession series (cine BSSFP) [20]. In patients with known Crohn's disease, inflamed small bowel segments can have motility changes which usually manifest as decreased or absent peristalsis compared to normal small bowel segments [21][22][23][24][25][26][27][28][29][30][31][32].…”

Small Bowel

“…One milligram of glucagon is enough to reach the desired effect while around 40 mg of hyoscine N-butylbromide is needed to achieve the same results. Some experiences in the literature found glucagon to have a more reliable and longer effect (Froehlich et al 2008). …”

Magnetic Resonance Imaging of the Bowel: Today and Tomorrow

“…To keep the motion-related artefacts to a minimum, the examination should be performed with the patient lying prone, since this reduces respiratory excursion, and an antispasmotic should be administered to suspend or significantly reduce intestinal motility. The appropriate antispasmotics are hyoscine butylbromide, (Buscopan, Boehringer Ingel- heim Pharma GmbH & Co KG, Germany) and glucagon, with studies showing glucagon to induce a longer period of spasmolysis [26]. Intravenous administration results in a faster and more reliable onset of effect [27].…”

“…Comparison of the motility of individual intestinal segments can expose initial pathologies, since small intestinal segments in particular normally exhibit a regular, uniform contraction. Fröh-lich et al measured the changes in intestinal segment diameter over time during this process [26]. Current software solutions make it possible to quantify the reduced or sus- pended bowel motility, by measuring the luminal diameter and plot it along the temporal axis [43].…”