Premedication with simethicone and N-acetylcysteine in improving visibility during upper endoscopy: a double-blind randomized trial

Abstract

Upper endoscopy is the most common method for the diagnosis of upper gastrointestinal tract diseases. The aim of this study was to determine whether premedication with simethicone or -acetylcysteine improves mucosal visualization during upper endoscopy. This was a randomized, double-blind, placebo-controlled study of 297 patients scheduled for upper endoscopy who were premedicated 15 - 30 minutes before the procedure with: 100 mL of water (placebo, group A); water plus 100 mg simethicone (group B); water plus 100 mg simethicone plus 600 mg -acetylcysteine (group C). The primary outcome measure was the quality of mucosal visualization (score: excellent, adequate or inadequate). The addition of simethicone (group B) or simethicone plus -acetylcysteine to the water (group C) improved the visualization scores of endoscopies compared with water alone (group A). In particular, groups B and C produced a significantly higher percentage of endoscopies with excellent visualization for the esophagus (91.1 % and 86.7 %, respectively, vs. 71.4 % in group A; < 0.001) and stomach (76.2 % and 74.5 % vs. 38.8 % in group A; < 0.001). For the duodenum, the use of simethicone also showed an increase in the endoscopies with excellent visualization compared with water alone (85.1 % vs. 73.5 %; = 0.042). There were no significant differences in scores between groups B and C or between gastric scores in patients with previous subtotal gastrectomy (B and C vs. A): 60.0 % and 42.1 % vs. 28.6 % ( = 0.14). The rate of reported lesions was higher in group B but without statistical significance. Premedication with simethicone resulted in better mucosal visibility. Such premedication might improve diagnostic yield, and should be considered for standard practice. Trial registered at ClinicalTrials.gov (NCT02357303).

Prevalence, Characteristics and Endoscopic Management of Gastric Premalignant Lesions in France

“…Moreover, most of the endoscopies performed in this study were without sedation or general anesthesia, thus limiting the tolerance of the procedure and the time spent to analyze the gastric mucosa. It has also been proven that the use of mucolytic agents (N-acetylcystein, simeticone) was efficient to improve the endoscopist's ability to detect lesions [33][34][35], but this procedure was routine practice at the time of the study.…”

Effect of premedication on lesion detection rate and visualization of the mucosa during upper gastrointestinal endoscopy: a multicenter large sample randomized controlled double-blind study

“…Therefore, both the drugs can improve the mucosal visibility of UGI endoscopy [ 6 , 10 , 11 ]. Previous studies on UGI endoscopy premedication have focused on mucosal visibility [ 4 , 7 , 9 , 12 – 15 ], and a recently published double-blind randomized trial has proved that both pronase and simethicone can result in better visibility [ 16 ]. However, the detection rate improvement on UGI early cancer and precancerous lesions through oral premedication has not been well evaluated.…”

Influence of Simethicone Added to the Rinse Water during Colonoscopies on Polyp Detection Rates: Results of an Unintended Cohort Study

“…A number of studies have demonstrated that the addition of simethicone to the bowel preparation improved the visibility [12,15] and a systematic review concluded that supplemental use of oral simethicone before endoscopy improves the small bowel visibility, decreases air bubbles in the colonic lumen but does not affect the completion rate of colonoscopies [16]. There is also improved visibility with pre-medication using simethicone before esophagogastroduodenoscopy [17,18]. However, to the best of our knowledge, this is the first observation that indicates that a minor modification such as the elimination of simethicone from the auxiliary channel water pump solution results in a substantial reduction of the polyp detection rate.…”