Year 2023 / Volume 115 / Number 1
Original
Prospective cohort study to evaluate premedication with simethicone and n-acetilcysteine for upper diagnostic gastrointestinal endoscopy

10-15

DOI: 10.17235/reed.2022.8576/2022

Esteban Fuentes-Valenzuela, Elena Pérez-Arenas, Marina de Benito Sanz, Carlos Chavarría, Aleida Miguel Peña, Ana Carbajo López, Javier Tejedor-Tejada, Beatriz Burgueño Gómez, Ramon Sánchez-Ocaña, María Albillos-Blanco, Almudena Salvador de las Heras, Francisco Javier García-Alonso,

Abstract
Introduction: The use of premedication for upper gastrointestinal endoscopy (UGE) is not widely established in western countries. The primary aim of the study was to compare gastric visibility according to the total visibility score (TVS). The secondary aim was to assess complications, diagnostic yield, endoscopic procedure time, sedation dose and patient satisfaction. Methods: A single center prospective cohort study was performed of consecutive adults undergoing an UGE in the afternoon working shift. After completing enrolment in the control group, patients were administered 200 mg simethicone and 500 mg N-acetylcysteine diluted in 100 ml of water >15 minutes before the procedure. All procedures were recorded and a single, blinded endoscopist evaluated the TVS after recruitment of both cohorts. Patient satisfaction was evaluated using the Spanish translation of the American Society of Gastrointestinal Endoscopy satisfaction questionnaire. Results: 205 patients were included in the study, 103 females (50.2%) with a median age of 54.8-years (IQR: 41.2-65.2). 104 were enrolled to the control group and 101 to the intervention group. Patients receiving premedication presented a higher rate of adequate (74.3% vs 45.2; difference 95% CI: 16,3-41,9%, p<0.001) and excellent gastric visibility (23.8% vs 7.7%; difference 95% CI: 6,3-25,8%, p=0.002). Propofol dose was similar, although the median procedure time was lower in the group of no intervention [5 (IQR: 4-7) vs 6 minutes (IQR: 5-7); p=0.03]. Procedure related adverse events were similar, except that patient without premedication experienced more nausea episodes. Major and minor endoscopic findings and the satisfaction questionnaire showed no differences between both groups. Conclusion: Patients receiving premedication with simethicone and N-acetylcysteine had a better gastric visibility score, without any increase in adverse events or affecting the patients’ satisfaction.
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References
1. Cohen J, Safdi MA, Deal SE, et al. Quality indicators for esophagogastroduodenoscopy. Gastrointest Endosc . 2006;63:S10–5.
2. Chang WK, Yeh MK, Hsu HC,et al. Efficacy of simethicone and N-acetylcysteine as premedication in improving visibility during upper endoscopy. J Gastroenterol Hepatol. 2014;29:769–74.
3. Elvas L, Areia M, Brito D,et al. Premedication with simethicone and N-acetylcysteine in improving visibility during upper endoscopy: A double-blind randomized trial. Endoscopy . 2017 ;49:139–45.
4. Monrroy H, Vargas JI, Glasinovic E, et al. Use of N-acetylcysteine plus simethicone to improve mucosal visibility during upper GI endoscopy: a double-blind, randomized controlled trial. Gastrointest Endosc. 2018;87:986–93.
5. Wu L, Cao Y, Liao C, et al . Systematic review and meta-analysis of randomized controlled trials of Simethicone for gastrointestinal endoscopic visibility. Scand J Gastroenterol. 2011;46:227–35.
6. Brečević L, Bošan-Kilibarda I, Strajnar F. Mechanism of antifoaming action of simethicone. J Appl Toxicol . 1994;14:207–11.
7. Chen MJ, Wang HY, Chang CW, et al. The add-on N-acetylcysteine is more effective than dimethicone alone to eliminate mucus during narrow-band imaging endoscopy: A double-blind, randomized controlled trial. Scand J Gastroenterol. 2013;48:241–5.
8. Li Y, Du F, Fu D. The effect of using simethicone with or without N-acetylcysteine before gastroscopy: A meta-analysis and systemic review. Saudi J Gastroenterol. 2019;25: 218-228.
9. Neale JR, James S, Callaghan J, et al. Premedication with N-acetylcysteine and simethicone improves mucosal visualization during gastroscopy: A randomized, controlled, endoscopist-blinded study. Eur J Gastroenterol Hepatol . 2013;25:778–83.
10. Chang WK, Yeh MK, Hsu HC,et al. Efficacy of simethicone and N-acetylcysteine as premedication in improving visibility during upper endoscopy. J Gastroenterol Hepatol. 2014;29:769–74.
11. Gotoda T, Uedo N, Yoshinaga S, et al. Basic principles and practice of gastric cancer screening using high-definition white-light gastroscopy: Eyes can only see what the brain knows. Dig Endosc. 2016;28:2–15.
12. Callaghan JL, Neale JR, Boger PC, et al. Variation in preparation for gastroscopy: Lessons towards safer and better outcomes. Frontline Gastroenterol. 2016 ;7:187–90.
13. Beg S, Ragunath K, Wyman A, et al. Quality standards in upper gastrointestinal endoscopy: A position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut. 2017 Nov;66(11):1886-1899.
14. Fernández-Esparrach G, Marín-Gabriel JC, Díez Redondo P, et al. Quality in diagnostic upper gastrointestinal endoscopy for the detection and surveillance of gastric cancer precursor lesions: Position paper of AEG, SEED and SEAP. Gastroenterol Hepatol . 2021 ;44:448–64.
15. Pimentel-Nunes P, Libânio D, Marcos-Pinto R, et al. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy. 2019;51:365–88.
16. Weusten B, Bisschops R, Coron E, Dinis-Ribeiro M, Dumonceau J-M, Esteban J-M, et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2017 Jan;49(02):191–8.
17. Sánchez Del Río A, Alarcón Fernández O, Baudet JS,et al. Validación de un cuestionario breve sobre satisfacción del paciente en endoscopia digestiva. Rev Esp Enfermedades Dig . 2005 ;97:554–61.
18. Kuo CH, Sheu BS, Kao AW, et al. A defoaming agent should be used with pronase premedication to improve visibility in upper gastrointestinal endoscopy. Endoscopy . 2002;34:531–4.
19. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010 ;71:446–54.
20. Basford P, Brown J, Gadeke L, , et al. A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy – NICEVIS. Endosc Int Open. 2016 ;04:E1197–202.
21. Manfredi G, Bertè R, Iiritano E, et al. Premedication with simethicone and N-acetylcysteine for improving mucosal visibility during upper gastrointestinal endoscopy in a Western population. Endosc Int Open. 2021;09:E190–4.
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Fuentes-Valenzuela E, Pérez-Arenas E, de Benito Sanz M, Chavarría C, Miguel Peña A, Carbajo López A, et all. Prospective cohort study to evaluate premedication with simethicone and n-acetilcysteine for upper diagnostic gastrointestinal endoscopy . 8576/2022


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Publication history

Received: 06/01/2022

Accepted: 14/03/2022

Online First: 17/03/2022

Published: 12/01/2023

Article revision time: 63 days

Article Online First time: 70 days

Article editing time: 371 days


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