Objective assessment of the antispasmodic effect of Shakuyaku-kanzo-to (TJ-68), a Chinese herbal medicine, on the colonic wall by direct spraying during colonoscopy

AIM:To objectively evaluate the effect of TJ-68 on colonic spasms during colonoscopy. METHODS:One hundred and one patients subjected to screening colonoscopy were randomly assigned to two groups: TJ-68 in 51 subjects and saline as the control in 50.The endoscope was inserted into the sigmoid colon, then a spastic region was identified and the tip of the colonoscope was positioned at a distance of about 10 mm from the spastic region.The endoscopic view was recorded before and after direct spraying of the TJ-68 solution or warm saline.The intraluminal area of the spastic region was serially measured using a computer image analyzer and expressed as pixel counts.The area under the curve (AUC) was calculated from the pixel curve.Statistical significance was assessed by Wilcoxon's test and Mann-Whitney U test. RESULTS:The mean AUC of the spastic region before and after TJ-68 spraying was 29 128 and 121 943 pixels, respectively, while with saline, it was 31 635 pixels and 48 617 pixels, respectively.Thus, the AUC significantly increased after TJ-68 spraying compared with the spraying of saline (P <0.001).CONCLUSION: Direct spraying of TJ-68 on the colonic mucosa suppressed colonic spasm and it may be useful during colonoscopy when anticholinergic agents are contraindicated.