A Clinical Analysis Of Scopolamine Hydrobromide In Probe-based Confocal Laser Endomicroscopy For Gastroendoscopy Examination

Background & Objective:Confocal laser endomicroscopy (CLE) is currently the only endoscopic technology that can reach the level of living tissue pathology. The tissue structure, cellular and subcellular structures can be clearly identified by the image magnified 1000 times, which makes it easier for physicians to make Immediate and accurate high resolutional histological diagnosis, take the corresponding treatment measures in a timely manner, and to avoid repeated endoscopic examination and multiple biopsy complications. Scopolamine Hydrobromide is one kind of M cholinergic receptor blocker, and it has been widely used in preoperative preparation of gastrointestinal endoscope due to its anticholinergic effects. Scopolamine Hydrobromide has been proved useful in ordinary gastroscopy operation, for it can alleviate the patient’s pain, and effectively improve the quality of gastroscope examination. However the effectiveness of Scopolamine Hydrobromide has not been confirmed in the confocal laser endomicroscopy in gastroscopy. This trial was conducted to study the effectiveness and safety of Scopolamine Hydrobromide applied to probe-based confocal laser endomicroscopy (pCLE) during operation.Methods:Consecutive clinic patients (aged 18-80 years old and no contraindication for Scopolamine Hydrobromide application) came to endoscopy room of Qilu Hospital, Shandong University for probe-based confocal laser endomicrogastroscopy in gastroendoscopy examination were enrolled and randomly divided into A, B two groups. A group patients received Scopolamine Hydrobromide 0.3mg for intramuscular injection, while B group patients were given normal saline injection before the examination. The probe of the pCLE inspected lesions and five standard parts (the greater curvature of antrum, the lesser curvature of antrum, the greater curvature of gastric body, the lesser curvature of gastric body, gastric angle) and a real-time score was made for the confocal image of every position. Biopsy was taken on the suspicious site, the whole time of gastroendoscopy operation and number of adverse reactions were recorded, and disease detection rate of two groups of patients was compared. For patients with biopsy, endoscope diagnostic accuracy of two group patients was compared under the golden standard of pathological diagnosis. Differences of above indicators between the two groups of patients were calculated.Results:A total of 122 patients had CLE examinations,6 of which were excluded for various reasons, leaving 116 patients included in this study. The results show no significant difference between the two groups in gender, age, height, weight, gastroendoscope detection rate, diagnostic accuracy and the incidence of adverse events. As for the scores of confocal images of the two group patients, the scores of the greater curvature of antrum and the greater curvature of gastric body have no statistical significance (X2=0.057, P= 0.811; X2= 2.939, P= 0.086). However, as for the lesser curvature of antrum, the lesser curvature of gastric body, gastric angle and lesion sites, the quality scores of confocal images of group A are higher than that of group B, and the results have statistical significance (X2= 9.046, P= 0.005; X2= 4.417, P= 0.036;X2= 9.979, P= 0.004;X2=8.849, P= 0.006). Compared with group B, gastroendoscope operation time of group A is significantly deseased(t=2.075, P=0.04).Conclusion:In the examination of probe-based confocal laser endomicroscopy in gastroendoscopy, the application of Scopolamine Hydrobromide can be of great use to get higher qualified image, and effectively improve the gastroendoscopy operation efficiency.