Sami Ghazaleh, MD, Azizullah Beran, MD, Christian Nehme, MD, Mohammed T. Awad, MD, Sachit Sharma, MD, Dipen Patel, MD, MBA; University of Toledo Medical Center, Toledo, OH
Introduction: Glucagon is an antispasmodic drug that may improve colonoscopy outcomes, but the exact effects of the drug remain unknown. The purpose of our meta-analysis was to investigate the role of glucagon in colonoscopy. Methods: We performed a comprehensive search in the literature for studies that evaluated the role of glucagon in colonoscopy. We searched the databases of PubMed/MEDLINE and Embase from inception until June 11, 2020. The search was not limited by language or study design. Two researchers (SG and AB) independently selected the studies; discrepancies were resolved by a third researcher (CN). We considered randomized controlled trials, cohort studies, case-control studies, and case series. We excluded animal studies, case reports, reviews, editorials, and letters to editors. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our outcomes were the cecal intubation time, withdrawal time, total intervention time, polyp detection rate, and occurrence of nausea. The random-effects model was used to calculate the mean differences (MD), odds ratios (OR), and confidence intervals (CI). Results: We included 6 randomized controlled trials (RCTs) with a total of 380 patients. The mean cecal intubation time was significantly lower in patients who received glucagon compared with patients who received placebo (MD: -1.63 min, 95% CI: -3.23 – -0.02, p = 0.047, I2 = 69%). No statistically significant difference was observed between glucagon and placebo in mean withdrawal time (MD: -0.03 min, 95% CI: -0.69 – 0.63, p = 0.93, I2 = 0%) or total intervention time (MD: -0.05 min, 95% CI: -2.65 – 2.54, p = 0.97, I2 = 60%). Polyp detection rate was similar between glucagon and placebo (OR: 1.03, 95% CI: 0.60 – 1.78, p = 0.98, I2 = 0%). Patients who received glucagon were more likely to complain of nausea compared with placebo (OR: 3.54, 95% CI: 1.22 – 10.27, p = 0.02, I2 = 14%). Discussion: Glucagon improves cecal intubation time but has no effect on withdrawal time, total intervention time, or polyp detection rate. One of the downsides of using the drug is more side effects including nausea. Future studies should investigate the effect of glucagon on adenoma detection rate which is the most important quality indicator for colonoscopy.
Meta-analysis of the studies that compared glucagon and placebo. Outcomes: Cecal intubation time, withdrawal time, and total intervention time.
Meta-analysis of the studies that compared glucagon and placebo. Outcomes: Polyp detection rate and occurrence of nausea
Disclosures: Sami Ghazaleh indicated no relevant financial relationships. Azizullah Beran indicated no relevant financial relationships. Christian Nehme indicated no relevant financial relationships. Mohammed Awad indicated no relevant financial relationships. Sachit Sharma indicated no relevant financial relationships. Dipen Patel indicated no relevant financial relationships.