Use of N-acetylcysteine plus simethicone to improve mucosal visibility during upper GI endoscopy: a double-blind, randomized controlled trial

Monrroy, Hugo; Vargas, José Ignacio; Glasinovic, Esteban; Cândia, Roberto; Azúa, E. Ruiz de; Gálvez, Camila; Rojas, Camila; Cabrera, Natalia; Vidaurre, Josefa; Alvarez, Natalia Miranda; Gonzalez, J.R.; Espino, Alberto; Gonzalez, Robinson G.; Parra‐Blanco, Adolfo

doi:10.1016/j.gie.2017.10.005

Cited by 49 publications

(55 citation statements)

References 25 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Chapelle

Péron

Mosnier

et al. 2019

Dig Dis

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Introduction: Surveillance of gastric precancerous lesions (GPL) is recommended, but the data on their clinical and endoscopic management in a "real-life" practice are limited. Our aim was to study the modalities of endoscopic management of patients with GPL in France. Design: All the patients diagnosed with GPL in our center between 2000 and 2015 were grouped and analyzed according to the most severe GPL found, in the following order: atrophic gastritis only (AG), intestinal metaplasia (IM), low grade dysplasia (LGD), high grade dysplasia (HGD). Results: Out of 16,764 patients having undergone upper endoscopy with gastric biopsies, 507 were identified with GPL (detection rate 3.2%). Overall, Helicobacter pylori infection was found in 41% of patients. IM was by far the most frequently found lesion (79%), followed by LGD (17%), HGD (2%), and AG only (2%). H. pylori infection rate was decreasing, while the age of the patients was increasing, together with the increasing severity of GPL (p = 0.005). Only 28% of the patients had at least one follow-up endoscopy. No correlation was found between the endoscopist's appreciation of the mucosa and histological results. Conclusion: In France, GPL can be expected in about 3% of patients undergoing upper endoscopy with gastric biopsies for any reason. The correlation between the endoscopic evaluation and histology is poor. Spreading of published guidelines should improve the management of patients with GPL in the future.

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Section: Discussionmentioning

confidence: 99%

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

Chapelle

Péron

Mosnier

et al. 2019

Dig Dis

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“…We read with great interest the letter by Spinzi et al 1 commenting on our article 2 and warning about simethicone and its potential harmful effect when it is used for GI endoscopy. We agree with their concerns based on reports of crystallization in the endoscope channels when simethicone is used in the water pump.…”

Section: Responsementioning

confidence: 98%

Use of N-acetylcysteine plus simethicone to improve mucosal visibility during upper GI endoscopy

Spinzi

Andrealli

Conforti

2018

Gastrointestinal Endoscopy

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We read with great interest the article by Monrroy et al 1 about the use of N-acetylcysteine (NAC) plus simethicone to improve mucosal visibility during upper GI endoscopy. The authors' findings show that the use of NAC plus simethicone before upper GI endoscopy improves visibility of the gastric mucosa, reduces the volume of water needed, and may increase the diagnostic yield of the examination. Simethicone is used in many departments, and no alternative product with the same properties is available. 2 In another multicenter, large-sample, randomized controlled study, premedication with pronase and simethicone did not increase lesion detection rates but significantly increased visibility of the upper GI mucosa. 3 However, words of caution about the use of simethicone have been recently expressed. The American Society for Gastrointestinal Endoscopy has acknowledged that products containing simethicone are not approved by the U. S. Food and Drug Administration, 4 and 5 liquid simethicone products were recalled in 2011 because of contamination with molds or Burkholderia cepacian species. 5 Simethicone is not soluble in water and alcohol; it is hydrophobic and may interfere with reprocessing and foster microbial growth. Recently, crystalline deposits of dimethicone have been noted within the colonoscope waterjet channel, and the elimination of these crystals was possible only with mechanical cleaning. 2 Repeated attempts at washing with warm water, paracetic acid, and precleaning detergent were unsuccessful. Crystal deposits may therefore eventually lead to occlusion of the waterjet channel. In another article, fluid containing simethicone remained inside endoscopes despite reprocessing. 6 One manufacturer of GI endoscopes (Olympus America, Center Valley, Pa) issued a warning letter stating that simethicone may compromise reprocessing effectiveness because of difficulties in removing it from surfaces. 7 We think that the impact of simethicone on reprocessing effectiveness merits further investigation and that more research into its safety is necessary before its widespread use.

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“…A total of 171 studies were identified from Scopus, Medline and other electronic databases. Among them, 7 RCTs (n=1,099), published until March 2018, were eligible for inclusion (28)(29)(30)(31)(32)(33)(34)(35)(36); and the reasons for ineligibility are described in PRISMA flow chart Figure 1. The extracted data from the included trials is given in Tables 1 and 2.…”

Section: Characteristics Of Selected Trialsmentioning

confidence: 99%

Improving the mucosal visualization at gastroscopy: a systematic review and meta-analysis of randomized, controlled trials reporting the role of Simethicone ± N-acetylcysteine

Sajid

Rehman

Chedgy

et al. 2018

Transl. Gastroenterol. Hepatol.

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Use of N-acetylcysteine plus simethicone to improve mucosal visibility during upper GI endoscopy: a double-blind, randomized controlled trial

Cited by 49 publications

References 25 publications

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

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

Use of N-acetylcysteine plus simethicone to improve mucosal visibility during upper GI endoscopy

Improving the mucosal visualization at gastroscopy: a systematic review and meta-analysis of randomized, controlled trials reporting the role of Simethicone ± N-acetylcysteine

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