Surgery Research and Practice / 2021 / Article / Tab 2

Review Article

Does Premedication with Mucolytic Agents Improve Mucosal Visualization during Oesophagogastroduodenoscopy: A Systematic Review and Meta-Analysis

Table 2

Summary of all studies included in the systematic review. Sim = Simethicone, NAC = N-Acetylcysteine, DMPS = Dimethicone, TMVS = Total mucosal Visibility Score, F = Female, M = Male.

Study IDMethodsParticipantsInterventionsOutcome measureAnatomical site assessedTiming of premedicationResult

Kuo et al. [8]Double blinded randomized trial160 patients randomized,
F (92) M (68) mean age 50
5 intervention groups: (100 mg DMPS), (100 mg DMPS + 100 ml water), (2000 units of pronase + 100 ml water), (2000 units pronase + 1.2 g sodium bicarbonate + water 100 ml), (2000U pronase + 1.2 g sodium bicarbonate + 100 mg DMPS + 100 ml water)
0 control group
1 to 4-point scale(4) gastric antrum, upper body, lower body, fundus10 minsNo adverse effects reported.
Premedication with pronase and DMPS in 100 ml water provides optimal visibility in upper gastrointestinal endoscopy.
Chang et al. [19]An endoscopist-blinded, prospective, randomized study147 randomized, F (77) M (70) mean age 464 intervention groups: (100 mg DMPS), (100 mg DMPS + 100 ml water), (20,000 IU pronase + 1.2 g Sodium bicarbonate + 100 mg DMPS + 100 ml water), (400 mg NAC + 100 mg DMPS + 100 ml water)
0 control group
1 to 4-point scale(4) gastric antrum, upper body, lower body, fundus20 minsNo adverse effects reported.
Premedication with 20000
U pronase, 1.2 g of sodium bicarbonate, 100 mg of DMPS plus up to 100 mL of warm water provided best TMVS
Keeratichananont et al. [21]Double blind, randomized, placebo controlled121 randomized,
F (66) M (55) mean age 57
1 intervention group: (133 mg sim + 60 ml water)
1 control group (60 ml water)
1 to 4-point scale(6) oesophagus, gastric fundus, body, antrum, incisura, duodenum15–30 minsNo adverse effects reported.
Simethicone solution was more effective than placebo in reducing obscuring foam and bubbles at all areas of upper gastrointestinal tract.
Asl et al. [18]Double blind, randomized, placebo controlled study148 randomized,
F (71) M (77) mean age 42
3 intervention groups: (100 mg DMPS + 100 ml water), (600 mg NAC+ 100 ml water), (100 mg DMPS + 600 mg NAC + 100 ml water)1 control group: (100 ml water)1 to 4-point scale(4) gastric antrum, upper body, lower body, fundus20 minsNo adverse effects reported.
100 mg activated dimethicone in water up to 100 mL provided superior TMVS
Cha et al. [20]Double blind randomized controlled trial55 patients randomized,
F (33) M (22) mean age 55
2 intervention groups: (20,000U pronase + 1g sodium bicarbonate + water), (80 mg sim)1 to 3-point scale(4) gastric antrum, upper body, lower body, fundus10 minsNo adverse effects reported.
Pronase solution provided a superior TMVS compared to simethicone.
Chang et al. [17]Randomized, investigator-blinded study1849 randomized,
F (864) M (985) mean age 54
3 intervention groups: (5 ml water + 100 mg sim), (100 ml water + 100 mg sim), (100 ML water + 100 mg sim + 200 mg NAC)
0 control group
1 to 3-point scale(7) oesophagus, fundus, upper body, lower body, antrum, duodenal bulb, D2)10–30 minsNo adverse effects reported.
100 mg of simethicone improves TMVS, enhanced by addition of NAC
Kim et al. [22]Multicentre, prospective, randomized, double blind study143 randomized,
F (56) M (87) mean age 59
2 intervention groups: (80 mg sim + 1g sodium bicarbonate + 20,000 U pronase + 100 ml water), (80 mg sim in 20 ml water)
0 control group.
1 to 4-point scale(4) gastric antrum, upper body, lower body, fundus10 minsNo adverse effects reported.
Pronase + simethicone group provided superior TMVS than simethicone alone.
Basford et al. [15]Randomized controlled clinical trial126 randomized,
F (64) M (62) mean age 62
2 intervention group: (50 ml water, 1G NAC, 60 mg sim), (50 ml water)
1 control group: (No pre-procedure drink)
1 to 4-point scale(4) oesophagus, gastric body, fundus, antrum5–10 minsNo adverse effects reported.
Simethicone + NAC premedication significantly improves TMVS.
Song et al. [14]Randomized, placebo controlled, endoscopist- blinded study54 randomized,
F (30) M (24) mean age 55
1 intervention group (100 mg sim + water)
1 control group: 5 ml water
1 to 4-point scale(4) oesophagus, antrum and angularis of the stomach, body and fundus, duodenum30 minsNo adverse effects reported.
Simethicone solution provided significantly improved TMVS compared to placebo.
Elvas et al. [16]Single-centre, prospective, double blind, placebo- controlled, randomized trial300 randomized,
F (148) M (152) mean age 62
2 intervention groups: (100 ml water + 100 mg sim), (100 ml water, 100 mg sim, 600 mg NAC)
1 control group (100 ml water)
Dichotomous: Excellent/Not excellent(3) oesophagus, stomach body and antrum, duodenum15–30 minsNo adverse effects reported.
Simethicone solution improves mucosal visibility, inconclusive effect of addition of NAC.
Liu et al. [23]Randomized, double blind, placebo controlled trial7143 randomized,
F (4159) M (2984) mean age 53
3 intervention groups: (20,000U pronase + 1g Sodium bicarb + 100 ml water), (80 mg simethicone + 100 ml water), (20,000U pronase + 80 mg simethicone + 1g Sodium bicarbonate + 100 ml water)
1 control group: (100 ml water)
1 to 3 scale(5) oesophagus, cardia, fundus, body, antrum20 minsNo adverse effects reported.
Simethicone solution was superior to pronase solution in improving TMVS, however the combination was superior still.
Monrroy et al. [12]Parallel assignment, double blinded, placebo- controlled randomized controlled trial230 randomized
F (156) M (74) mean age 49
4 intervention groups: (50 ml water), (W + Sim200 mg), (W + sim + NAC 500 MG), (W + sim + NAC 1000 MG)
1 control group: No intervention
1 to 4-point scale(4) gastric antrum, upper body, lower body, fundus20 minsNo adverse effects reported.
Simethicone and NAC solution improves TMVS.
Zhang et al. [13]Prospective, single blinded, randomized controlled trial610 randomized,
F (362) M (248) mean age 50
1 intervention group: (80 mg sim + 1G sodium bicarbonate + 20,000IU pronase)
1 control group: 10 mL lidocaine hydrochloride mucilage
1 to 4-point scale(5) oesophagus, gastric antrum, upper body, lower body, fundus20 minsNo adverse effects reported.
Simethicone and pronase solution improved TMVS.