L-menthol a safe peristaltic alternative to HBB for older adults undergoing EGD

L-menthol can effectively reduce peristaltic grade in older adults scheduled for esophagogastroduodenoscopy (EGD) with a contraindication to hyoscine-N-butylbromide (HBB), a recent study has found.

Researchers conducted a prospective, randomized, double-blinded, placebo-controlled trial enrolling 52 elderly patients (aged ≥65 years) who were set to undergo EGD. All patients had a contraindication for HBB. Half (n=26) were assigned to receive L-menthol as an antiperistaltic agent, while the remaining half received placebo. The primary outcome of interest was the proportion of patients with no (grade 1) or mild (grade 2) peristalsis after medication and at the end of the procedure.

Significantly more patients in the L-menthol vs placebo arm successfully achieved the primary outcome (76.9 percent vs 11.5 percent; p<0.001). Endoscopic imaging also showed that L-menthol administration could quickly and clearly stop gastric peristalsis and induce pyloric relaxation.

Moreover, treatment with L-menthol led to a significant drop in median peristaltic score, decreasing from a median of 4 points at baseline, to 1.5 (p<0.001) and 1 (p<0.001) points after medication and at the end of the procedure, respectively. In contrast, median peristaltic score at baseline was 4 points in the placebo group and was statistically unchanged throughout the study.

“The present study demonstrates that l-menthol is an effective and safe alternative antiperistaltic medication for EGD in elderly patients with contraindication to HBB,” the researchers said. “Further large, randomized trials are required to clarify whether l-menthol can lead to better detection yield in the elderly.”