Premedication with simethicone and N-acetylcysteine for improving mucosal visibility during upper gastrointestinal endoscopy in a Western population

Abstract Background and study aim Pre-endoscopic use of a preparation with tensioactive and mucolytic agents improved gastric mucosa visualization in Eastern studies. Data on Western population are scanty. Patients and methods This prospective, endoscopist-blinded, randomized study enrolled patients...

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Bibliographic Details
Published in:	Endoscopy International Open Vol. 9; no. 2; pp. E190 - E194
Main Authors:	Manfredi, Guido, Bertè, Roberto, Iiritano, Elena, Alicante, Saverio, Londoni, Claudio, Brambilla, Giancarlo, Romeo, Samanta, Menozzi, Fernanda, Griffanti, Paola, Brandi, Giovanna, Moreschi, Oliva, Pezzilli, Raffaele, Zullo, Angelo, Buscarini, Elisabetta
Format:	Journal Article
Language:	English
Published:	Rüdigerstraße 14, 70469 Stuttgart, Germany Georg Thieme Verlag KG 01-02-2021
Subjects:	Original article
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Summary:	Abstract Background and study aim Pre-endoscopic use of a preparation with tensioactive and mucolytic agents improved gastric mucosa visualization in Eastern studies. Data on Western population are scanty. Patients and methods This prospective, endoscopist-blinded, randomized study enrolled patients who underwent esophagogastroduodenoscopy in a single center. Before endoscopy patients, were randomized to receive or not receive an oral preparation with simethicone and N-acetylcysteine in water. A pretested score (Crema Stomach Cleaning Score [CSCS]) for gastric mucosa cleaning evaluation was used. In detail, the stomach was divided into the antrum, body, and fundus and a score of 1 to 3 was assigned to each part (the higher the score, the better the preparation), and a total value ≤ 5 was considered as insufficient. Time between endoscope insertion and clean achievement (mouth to clean time) or the end of examination (mouth to mouth time) was recorded. Results A total of 197 patients were enrolled. The mean overall CSCS value and mucosal cleaning in all parts was better in treated patients than in controls. Prevalence total score ≤ 5 was significantly lower in patients treated before endoscopy. Need for water flush occurred less frequently in treated patients (P < 0.0001). The mouth to clean time was lower in the treated than in the control group (2.3 ± 1.6 vs 3.8 ± 1.6 min; P < 0.001), whereas no significant difference in mouth to mouth time emerged. Conclusions Data from this study show that premedication with simethicone and N-acetylcysteine results in significantly better endoscopic visualization of gastric mucosa, and the proposed CSCS could be useful for standardizing this evaluation.
ISSN:	2364-3722 2196-9736
DOI:	10.1055/a-1315-0114