Efficacy of simethicone and <scp>N</scp>‐acetylcysteine as premedication in improving visibility during upper endoscopy

Chang, Wei‐Kuo; Yeh, Ming–Kung; Hsu, Hsuang-Chun; Chen, Hsuan-Wei; Hu, Ming‐Kuan

doi:10.1111/jgh.12487

Cited by 44 publications

(59 citation statements)

References 25 publications

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“…15 A mixture of Nacetylcysteine to dissolve the overlying superficial mucus and polydimethylsiloxane to remove saliva bubbles was administered 20 minutes before the endoscopy examination. 16,17 Chromoendoscopy was performed to clearly distinguish the margins of the lesions by using a 0.25% solution of indigo carmine dye injected directly into the working channel of the endoscope with a 20-mL disposable syringe. 18 For all referral cases, an additional preoperative evaluation was conducted for endoscopic confirmation of the margins and to determine the appropriate ESD strategy to be used on each patient.…”

Section: Diagnosis Of Egcmentioning

confidence: 99%

Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video)

Emura¹,

Mejía²,

Donneys³

et al. 2015

Gastrointestinal Endoscopy

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Section: Diagnosis Of Egcmentioning

confidence: 99%

Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video)

Emura¹,

Mejía²,

Donneys³

et al. 2015

Gastrointestinal Endoscopy

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“…Several studies have demonstrated that drinking a defoaming agent before a procedure improves mucosal visibility 7 8. Results are conflicting among studies that have examined whether the addition of a mucolytic such as N-acetylcysteine (NAC) to a defoaming agent offers any further benefit 9 10 11 12 13.…”

Section: Introductionmentioning

confidence: 99%

A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy – NICEVIS

et al. 2016

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Background and study aims: Mucosal views can be impaired by residual bubbles and mucus during gastroscopy. This study aimed to determine whether a pre-gastroscopy drink containing simethicone and N-acetylcysteine improves mucosal visualisation. Patients and methods: We conducted a randomized controlled trial recruiting 126 subjects undergoing routine gastroscopy. Subjects were randomized 1:1:1 to receive: A—pre-procedure drink of water, simethicone and N-acetylcysteine (NAC); B—water alone; or C—no preparation. Study endoscopists were blinded to group allocation. Digital images were taken at 4 locations (lower esophagus/upper gastric body/antrum/fundus), and rated for mucosal visibility (MV) using a 4-point scale (1 = best, 4 = worst) by 4 separate experienced endoscopists. The primary outcome measure was mean mucosal visibility score (MVS). Secondary outcome measures were procedure duration and volume of fluid flush required to achieve adequate mucosal views. Results: Mean MVS for Group A was significantly better than for Group B (1.35 vs 2.11, P < 0.001) and Group C (1.35 vs 2.21, P < 0.001).Mean flush volume required to achieve adequate mucosal views was significantly lower in Group A than Group B (2.0 mL vs 31.5 mL, P = 0.001) and Group C (2.0 mL vs 39.2 mL P < 0.001). Procedure duration did not differ significantly between any of the 3 groups.MV scores at each of the 4 locations demonstrated significantly better mucosal visibility in Group A compared to Group B and Group C (P < 0.0025 for all comparisons). Conclusions: A pre-procedure drink containing simethicone and NAC significantly improves mucosal visibility during gastroscopy and reduces the need for flushes during the procedure. Effectiveness in the lower esophagus demonstrates potential benefit in Barrett’s oesophagus surveillance gastroscopy.

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“…However, there is significant heterogeneity between these studies in terms of premedication time, mucosal scoring systems, primary outcome measurements and the type of medications used. Pronase, N-acetylcysteine, dimethicone, dimethylpolysiloxane and simethicone have all been demonstrated by multiple studies to be effective mucolytic and anti-foaming agents[3-11]. All the studies suggested that the best premedication regime is a combination of premedication (a mucolytic and an anti-foaming agent) delivered at large volumes (typically with 100 mL of water).…”

Section: Introductionmentioning

confidence: 99%

“…All the studies suggested that the best premedication regime is a combination of premedication (a mucolytic and an anti-foaming agent) delivered at large volumes (typically with 100 mL of water). Only one study had a treatment arm looking at small volume premedication (100 mg simethicone in 5 mL water) but this was not compared against a placebo group and the study used a unique 3-grade scoring system[11]. …”

Section: Introductionmentioning

confidence: 99%

Efficacy of small-volume simethicone given at least 30 min before gastroscopy

Song¹,

Kwek²,

Law³

et al. 2016

WJGPT

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AIMTo evaluate the efficacy of 5 mL simethicone solution in decreasing gastric foam if given at least 30 min before gastroscopy.METHODSThis was a randomized, placebo controlled, endoscopist blinded study performed at Changi General Hospital. Patients were at least 21 years old, had no prior surgical resection of the upper gastrointestinal tract, and scheduled for elective diagnostic gastroscopies. The primary outcome was the total mucosal visibility score (TMVS) which was evaluated using McNally score. The sample size was calculated to be 24 per group (SD 2.4, 80% power, P < 0.05, 2-sample t test).RESULTSFifty-four patients were randomised to receive either simethicone [1 mL liquid simethicone (100 mg) in 5 mL of water] or placebo (5 mL of water) at least 30 min before their gastroscopy. Six accredited consultants conducted the gastroscopy, and the interobserver agreement of scoring TMVS was good with a Kappa statistic of 0.73. The simethicone group had significantly better mean TMVS compared to placebo (5.78 ± SD 1.65 vs 8.89 ± SD 1.97, P < 0.001). The improvement was statistically significant for the duodenum and the gastric antrum, angularis, body, and fundus. Percent 51.9 of patients in the simethicone group had a TMVS of 4 (no bubbles at all) to 5 (only 1 area with minimal bubbles), while in the placebo group 3.7% of patients had TMVS of 4 or 5. The number needed to treat was 2.1 to avoid a TMVS of 6 and more. The simethicone group also had a significantly shorter procedure time with less volume of additional flushes required during gastroscopy to clear away obscuring gastric foam.CONCLUSIONWith a premedication time of at least 30 min, 5 mL simethicone can significantly decrease gastric foam, decrease the volume of additional flushes, and shorten gastroscopy time.

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Efficacy of simethicone and N‐acetylcysteine as premedication in improving visibility during upper endoscopy

Cited by 44 publications

References 25 publications

Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video)

Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video)

A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy – NICEVIS

Efficacy of small-volume simethicone given at least 30 min before gastroscopy

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