Endoscopic flushing with pronase improves the quantity and quality of gastric biopsy: a prospective study

Lee, Sun‐Young; Han, Hye Seung; M., Jae; Cho, Yu K.; Kim, Gwang H.; Chung, Il‐Kwun

doi:10.1055/s-0034-1365811

Cited by 10 publications

(7 citation statements)

References 9 publications

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“…Detecting these premalignant tissues is important in planning surveillance for such patients in detecting early gastric cancer. Similar finding was noted by SY Lee et al ., who used a flushing technique for the application of Pronase that facilitated improvement in depth of the biopsy, anatomical orientation and overall diagnostic adequacy. More findings of atrophic gastritis and intestinal metaplasia are also very important because they are associated with early gastric cancer .…”

Section: Discussionsupporting

confidence: 84%

Efficacy and safety of using premedication with simethicone/Pronase during upper gastrointestinal endoscopy examination with sedation: A single center, prospective, single blinded, randomized controlled trial

Zhang

et al. 2017

Digestive Endoscopy

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Background and Aim: To investigate the efficacy and safety of premedication with simethicone/Pronase during esophagogastroduodenoscopy (EGD) with sedation.Methods: Six hundred and ten patients were randomly allocated to two groups based on type of premedication given. Premedication used in the control group was 10 mL lidocaine hydrochloride mucilage (LHM, N = 314) and premedication used in the intervention group was 80 mL simethicone/Pronase solution plus 10 mL lidocaine hydrochloride mucilage (SP/LHM, N = 296). EGD was done under sedation. Visibility scores, number of mucosal areas that needed cleansing, water consumption for cleansing, time taken for examination, diminutive lesions, pathological diagnosis, patients' gag reflex and oxygenation (pulse oximetry) were recorded.Results: SP/LHM has significantly lower total visibility score than LHM (7.978 AE 1.526 vs 6.348 AE 1.097, P < 0.01). During the procedure, number of intragastric areas that needed cleansing and amount of water consumed were significantly less in the SP/LHM than in the LHM group (P < 0.01). In SP/LHM (P = 0.01), endoscopy procedure duration was significantly longer. Although there was no significant difference in rate of detection of diminutive lesions between LHM and SP/LHM, the endoscopist carried out more biopsies in SP/LHM. This led to a higher rate of diagnosis of atrophic gastritis (P = 0.014) and intestinal metaplasia (P = 0.024). There was no significant difference in gag reflex (P = 0.604) and oxygenation during the endoscopy procedure for either group of patients. Conclusion:Routine use of premedication with simethicone/ Pronase should be recommended during EGD with sedation.

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Section: Discussionsupporting

confidence: 84%

Efficacy and safety of using premedication with simethicone/Pronase during upper gastrointestinal endoscopy examination with sedation: A single center, prospective, single blinded, randomized controlled trial

Zhang

et al. 2017

Digestive Endoscopy

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“…To improve the accuracy of biopsy, a previous study used pronase to wash the mucosal surface of the lesions, which increased the depth of the biopsy, facilitated accurate positioning, and helped improve the accuracy of the biopsy. 18 In addition, Jiang et al 19 have shown that a targeted biopsy with ME-NBI could achieve a high pathological positive rate with a small quantity of tissues. However, targeted biopsy with ME-NBI increases the difficulty of the biopsy procedure.…”

Section: Discussionmentioning

confidence: 99%

Low Discrepancy Between Tissue Biopsy Plus Magnifying Endoscopy With Narrow-Band Imaging and Endoscopic Resection in the Diagnosis of Gastric Epithelial Neoplasia (STROBE)

et al. 2015

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Tissue biopsy is often not very accurate for the diagnosis of gastric epithelial neoplasia (GEN), and the results differ notably from endoscopic resection (ER) in terms of the pathological diagnosis. The aims of this study were to evaluate the diagnostic performances of biopsy, magnifying endoscopy with narrow-band imaging (ME-NBI), and biopsy plus ME-NBI for GEN.This study retrospectively analyzed 101 cases diagnosed as GEN using ER samples. The discrepancies between biopsy and ER, as well as between biopsy plus ME-NBI and ER in the diagnosis of GEN were evaluated. Factors that contributed to such discrepancies were analyzed. The sensitivity and specificity of biopsy and ME-NBI for the diagnosis of high-grade neoplasia (HGN) were determined.The discrepancy in the pathological diagnosis between biopsy and ER was 39.6% for GEN and 54.2% for HGN. The discrepancy between biopsy combined with ME-NBI and ER was 15.9% for GEN and 10.2% for HGN. Factors that undermined the diagnostic accuracy of biopsy included the lesion size (≤10 mm, odds ratio [OR] 1; 10–20 mm, OR 0.2, 95% confidence interval [CI] 0.1–0.7; >20 mm, OR 0.5, 95% CI 0.1–2.1, P = 0.03) and the number of biopsy fragments (OR 0.6, 95% CI 0.5–0.8, P = 0.001). The sensitivity and specificity for HGN were 45.8% (33.7%–58.3%) and 100% (87.5%–100%) for biopsy, and 88.1% (77.5%–94.1%) and 92.9% (81.0%–97.5%) for ME-NBI, respectively.In conclusion, biopsy-based diagnoses for GEN should be interpreted with caution. Biopsy combined with ME-NBI can contribute to the diagnosis of GEN, which improves diagnostic consistency with pathological result of ER specimens.

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“…In this study, gastric mucus reduced capsule navigability in three patients. Removal of mucus by drugs such as simethicone [15] and pronase [16] has been shown to alleviate the problem, but their use requires fur- ther investigation. An air-water interface is required for navigation of the capsule within the stomach, and most patients tolerated ingestion of the large amount of water.…”

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confidence: 99%

Magnetic-controlled capsule endoscopy vs. gastroscopy for gastric diseases: a two-center self-controlled comparative trial

et al. 2015

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Endoscopic flushing with pronase improves the quantity and quality of gastric biopsy: a prospective study

Abstract: Endoscopic flushing with pronase not only improved the depth of biopsy but also the anatomical orientation and overall diagnostic adequacy. Pronase can be recommended for flushing during EGD to improve the quantity and quality of biopsy.

Cited by 10 publications

References 9 publications

Efficacy and safety of using premedication with simethicone/Pronase during upper gastrointestinal endoscopy examination with sedation: A single center, prospective, single blinded, randomized controlled trial

Efficacy and safety of using premedication with simethicone/Pronase during upper gastrointestinal endoscopy examination with sedation: A single center, prospective, single blinded, randomized controlled trial

Low Discrepancy Between Tissue Biopsy Plus Magnifying Endoscopy With Narrow-Band Imaging and Endoscopic Resection in the Diagnosis of Gastric Epithelial Neoplasia (STROBE)

Magnetic-controlled capsule endoscopy vs. gastroscopy for gastric diseases: a two-center self-controlled comparative trial

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