Assessment of antispasmodic effect of Herbal Medicine, Shakuyaku-kanzo-to (TJ-68) by direct spraying during colonoscopy

Background : Cholinergic blocking agents are regularly used to reduce colonic spasm in colonoscopy. However, these agents are thought to be contraindication for heart disease, prostate hypertrophy, or glaucoma. The aim of this study is to evaluate the effect of intracolonic spraying of Herbal Medicine, Shakuyaku-kanzo-to (TJ-68) on the suppression of colonic spasm during colonoscopy. Subject and methods : Twenty-six patients underwent colonoscopy without premedication. An endoscope was inserted from anal canal about to 25 cm of sigmoid colon. Then, identifying a certain colonic spastic region and keeping the distance between the spastic region and the tip of the colonoscope, the endoscopic view was recorded on digital videotape for 3 minutes before and after spraying of TJ-68 solution (0.5g of TJ-68 dissolved in 50 ml of lukewarm water) through a working channel. The 12 spot images recorded were selected every 3 minutes for the assessment of luminal change. The intraluminal area of the spastic region was measured with the computer image analyzer (Adobe Photoshop 7.0) and expressed as pixel counts. The areas under the curve (AUC) were calculated from the pixel curve obtained before and after the spraying of TJ-68. Results : The mean AUC before and after the TJ-68 spraying was 41,057 pixels and 98,348 pixels, respectively. Thus, AUC significantly increased after the TJ-68 spraying. Conclusion : A direct spraying of the TJ-68 on the colonic mucosa proved to suppress the colonic spasm. TJ-68 was suggested to be useful as a premedication of colonoscopy when the patients are not amenable to cholinergic blocking agent.