Use of cimetropium bromide as premedication was significantly associated with increased gastric neoplasm detection rates during esophagogastroduodenoscopy (EGD) screening, according to study findings published in JAMA Network Open.

The propensity score-matched retrospective cohort study included participants who received comprehensive health screening at a hospital in South Korea from January 2, 2010, to June 30, 2017.

The participants were categorized into 2 groups: those who received cimetropium bromide before EGD (intervention group) and those who did not (control group). The antispasmodic agent, cimetropium bromide (5 mg), was administered intravenously 10 minutes before the EGD examination. The primary outcome was the gastric neoplasm detection rate during EGD screening.


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A total of 67,683 Asian participants who received EGD screening were enrolled in the study. Their mean age was 48.6±10.8 years, and 54.0% were men.

Of the cohort, 28,280 participants (41.8%) received cimetropium bromide before the EGD, and 39,403 (58.2%) did not. The intervention group (57.8% men) had a mean age of 50.3±10.6 years, and the control group (51.2% men) had a mean age of 47.4±10.8 years (P <.001).

A total of 41,670 participants who received and did not receive cimetropium bromide were propensity score matched (1:1) according to potential confounding variables.

Among participants in the propensity score-matched cohorts, gastric neoplasms were diagnosed in 102 individuals (0.24%), with 40 early cancers (0.10%), 52 dysplasias (0.12%), 3 lymphomas (0.01%), and 7 advanced cancers (0.02%) detected. Of the total 102 gastric neoplasms, 35 (34.3%) were small gastric lesions (<1 cm), and most neoplasms were detected in the gastric body (48.0%) and antrum (48.0%).

Neoplasm detection rates in the propensity score-matched cohorts were significantly higher in the intervention group (0.30%) vs the control group (0.19%; P =.02). The combined detection rate remained significantly higher in the intervention group (0.27%) vs the control group (0.17%; P =.02) when only accounting for dysplasia and early gastric cancer.

The detection rate of small gastric lesions was significantly higher in the intervention group (0.12%) vs the control group (0.05%; P =.03). Neoplasms in the gastric body were observed more frequently in the intervention group (0.16%) vs the control group (0.07%; P =.007).

Multivariate analyses in the full cohort showed that use of cimetropium bromide was more likely to detect gastric neoplasms compared with nonuse (odds ratio, 1.42; 95% CI, 1.04-1.95; P =.03).

Among several study limitations, data were unavailable for some covariates, which could be a source of bias. In addition, cimetropium bromide may not be available in all countries, and the investigators could not directly evaluate the extent of peristalsis after the injection of cimetropium bromide during EGD examination.

“This cohort study found a significant association between the use of cimetropium bromide as premedication and improvements in the detection rate of total gastric neoplasms, gastric dysplasia, and early gastric cancer during EGD screening,” the researchers wrote. “These findings suggest that cimetropium bromide may be considered for use as premedication before EGD examination among individuals with no contraindications.”

Reference

Kim SY, Park JM, Cho HS, Cho YK, Choi M-G. Assessment of cimetropium bromide use for the detection of gastric neoplasms during esophagogastroduodenoscopy. JAMA Netw Open. Published online March 23, 2022. doi:10.1001/jamanetworkopen.2022.3827