A prospective randomized controlled trial comparing simethicone, N-acetylcysteine, sodium bicarbonate and peppermint for visualization in upper gastrointestinal endoscopy

Mahawongkajit, Prasit; Kanlerd, Amonpon

doi:10.1007/s00464-020-07397-8

Cited by 6 publications

(6 citation statements)

References 32 publications

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“…Serving a solution of N-acetylcysteine and simethicone to drink before endoscopy may be a perspective. 14 To our knowledge, this is the first study to show that the ability of the mucosa to absorb MB correlates with the presence of diffuse IM and the percentage of metaplastic cells on high-power field histological examination. The percentage of the sample surface comprised of the metaplastic cells in the histopathological sample was the strongest predictor of positive MB staining in the multivariate logistic regression analysis.…”

Section: Discussionmentioning

confidence: 71%

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Methylene blue chromoendoscopy is more useful in detection of intestinal metaplasia in the stomach than mucosal pit pattern or vessel evaluation and predicts advanced Operative Link on Gastric Intestinal Metaplasia stages

et al. 2023

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Background/Aims: Intestinal metaplasia (IM) of the stomach is a precancerous condition that is often not visible during conventional endoscopy. Hence, we evaluated the utility of magnification endoscopy and methylene blue (MB) chromoendoscopy to detect IM.Methods: We estimated the percentage of gastric mucosa surface staining with MB, mucosal pit pattern, and vessel visibility and correlated it with the presence of IM and the percentage of metaplastic cells in histology, similar to the Operative Link on Gastric Intestinal Metaplasia (OLGIM) stage.Results: IM was found in 25 of 33 (75.8%) patients and in 61 of 135 biopsies (45.2%). IM correlated with positive MB staining (p<0.001) and other than dot pit patterns (p=0.015). MB staining indicated IM with better accuracy than the pit pattern or vessel evaluation (71.7% vs. 60.5% and 49.6%, respectively). At a cut-off point of 16.5% for the MB-stained gastric surface, the sensitivity, specificity, and accuracy of chromoendoscopy in the detection of advanced OLGIM stages were 88.9%, 91.7%, and 90.9%, respectively. The percentage of metaplastic cells detected on histology was the strongest predictor of positive MB staining.Conclusions: MB chromoendoscopy can serve as a screening method for detecting advanced OLGIM stages. MB mainly stains IM areas with a high concentration of metaplastic cells.

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Section: Discussionmentioning

confidence: 71%

“…Serving a solution of N-acetylcysteine and simethicone to drink before endoscopy may be a perspective. 14 …”

Section: Discussionmentioning

confidence: 99%

Methylene blue chromoendoscopy is more useful in detection of intestinal metaplasia in the stomach than mucosal pit pattern or vessel evaluation and predicts advanced Operative Link on Gastric Intestinal Metaplasia stages

et al. 2023

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“…These findings are similar to that reported by several other studies on NAC + simethicone in UGIE. 8,9,10,12,26 There have been some studies that did not find any added advantage of adding NAC to simethicone. 27 However, we believe use of mucolytic agent offers additional advantage over the defoaming effect of simethicone in clearing the adherent gastric mucus.…”

Section: Discussionmentioning

confidence: 99%

Pre-Endoscopy Drink of Simethicone and N-Acetylcysteine Significantly Improves Visualization in Upper Gastrointestinal Endoscopy

Anikhindi

Kumar

Uedo

et al. 2021

Journal of Digestive Endoscopy

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Introduction With the advancements in diagnostic and therapeutic upper gastrointestinal endoscopy (UGIE), clear mucosal visualization is essential to ensure optimal outcomes. Though routinely followed in Japan and Korea, pre-endoscopic preparation is seldom used in India. We evaluated the efficacy of a pre-endoscopic drink of N-acetylcysteine (NAC) and simethicone in improving mucosal visibility during UGIE. Patients and Methods This study was a retrospective, investigator blind study with a case–control study design. Cases included patients who received a pre-endoscopy drink of NAC and simethicone in 100 mL water administered 10 to 30 minutes prior to UGIE. Controls only had mandatory fasting for 6 to 8 hours prior to UGIE. Propensity score matching was done to ensure comparability between the groups. Digital images were taken at six standard landmarks during UGIE and stored. A blinded investigator subsequently analyzed the images and rated the mucosal visibility on a 3-point scale. The difference in the mean mucosal visibility between the cases and controls was compared. Results Mean mucosal visibility during UGIE was significantly better using NAC with simethicone as compared with no preparation at esophagus (1.14 [0.37] vs. 1.47 [0.62], p < 0.05), gastric fundus (1.10 [0.30] vs. 1.55 [0.64], p < 0.05), gastric body (1.22 [0.50] vs. 1.62 [0.73], p < 0.05), gastric antrum (1.13 [0.37] vs. 1.47 [0.62], p < 0.05), and duodenal bulb (1.13 [0.34] vs. 1.33 [0.56], p < 0.05). In distal duodenum, though visibility improved with NAC with simethicone, the difference was insignificant. There were no adverse events related to the pre-endoscopy drink. Conclusion A pre-endoscopy drink of NAC with simethicone can significantly improve mucosal visibility during UGIE. It is safe, cheap, easily available and maybe considered for routine utilization for ensuring optimal endoscopic outcomes.

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“…Resulta importante aclarar que los estudios sobre la detección de CPCs y LPCs, fueron realizados por expertos, previa preparación de limpieza del estómago, y con un estudio meticuloso de la mucosa gástrica. En la práctica diaria, la mayoría de las EDAs se hacen sin una preparación previa, la cual demostró ser más eficaz (63,64) , sin eliminar adecuadamente todos los restos de la secreción mucosa pegada a la pared gástrica con el simple lavado y aspiración (65) , sin tomar el tiempo suficiente para evaluar de forma meticulosa y metodológica la mucosa gástrica, como la metodología de evaluación de la mucosa gástrica sugerida por Emura et al (endoscopia sistemática alfanumérica codificada) (66) y sin tomar siempre biopsias según el protocolo de Sydney en la primera EDA diagnóstica (67) . Estas limitaciones seguramente impactan negativamente en nuestra capacidad de reconocimiento de las CPCs y LPCs (cuya detección permite un seguimiento y manejo apropiado) y del CGT (cuyo tratamiento tiene un excelente pronóstico).…”

Section: Conclusionesunclassified

¿Por qué es importante detectar la gastritis atrófica y la metaplasia intestinal gástrica? ¿Cuál es la forma adecuada de hacerlo?

Sarem¹,

Corti²

2020

Rev Gastroenterol Peru

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La metaplasia intestinal gástrica y la gastritis atrófica son condiciones precancerosas conocidas (CPCs) del estómago, lo que significa que los pacientes con CPCs están en riesgo de desarrollar cáncer gástrico y, por lo tanto, el diagnóstico y la categorización de riesgo para estos pacientes es un tema relevante. El objetivo de esta revisión es proporcionar una actualización sobre el problema, el diagnóstico y el manejo de las CPCs con énfasis en el papel de la detección endoscópica adecuada.

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A prospective randomized controlled trial comparing simethicone, N-acetylcysteine, sodium bicarbonate and peppermint for visualization in upper gastrointestinal endoscopy

Cited by 6 publications

References 32 publications

Methylene blue chromoendoscopy is more useful in detection of intestinal metaplasia in the stomach than mucosal pit pattern or vessel evaluation and predicts advanced Operative Link on Gastric Intestinal Metaplasia stages

Methylene blue chromoendoscopy is more useful in detection of intestinal metaplasia in the stomach than mucosal pit pattern or vessel evaluation and predicts advanced Operative Link on Gastric Intestinal Metaplasia stages

Pre-Endoscopy Drink of Simethicone and N-Acetylcysteine Significantly Improves Visualization in Upper Gastrointestinal Endoscopy

¿Por qué es importante detectar la gastritis atrófica y la metaplasia intestinal gástrica? ¿Cuál es la forma adecuada de hacerlo?

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