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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2021; 12(01): 011-018
DOI: 10.1055/s-0041-1726225
Original Article

Pre-Endoscopy Drink of Simethicone and N-Acetylcysteine Significantly Improves Visualization in Upper Gastrointestinal Endoscopy

Shrihari Anil Anikhindi
1   Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
,
Ashish Kumar
1   Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
,
Noriya Uedo
2   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Vikas Singla
1   Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
,
Akshay Anikhindi
3   Pravara Institute of Medical Sciences, Loni, Maharashtra, India
,
Praveen Sharma
1   Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
,
Naresh Bansal
1   Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
,
Piyush Ranjan
1   Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
,
Mandhir Kumar
1   Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
,
Munish Sachdeva
1   Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
,
Shivam Khare
1   Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
,
Anil Arora
1   Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
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Abstract

Introduction With the advancements in diagnostic and therapeutic upper gastrointestinal endoscopy (UGIE), clear mucosal visualization is essential to ensure optimal outcomes. Though routinely followed in Japan and Korea, pre-endoscopic preparation is seldom used in India. We evaluated the efficacy of a pre-endoscopic drink of N-acetylcysteine (NAC) and simethicone in improving mucosal visibility during UGIE.

Patients and Methods This study was a retrospective, investigator blind study with a case–control study design. Cases included patients who received a pre-endoscopy drink of NAC and simethicone in 100 mL water administered 10 to 30 minutes prior to UGIE. Controls only had mandatory fasting for 6 to 8 hours prior to UGIE. Propensity score matching was done to ensure comparability between the groups. Digital images were taken at six standard landmarks during UGIE and stored. A blinded investigator subsequently analyzed the images and rated the mucosal visibility on a 3-point scale. The difference in the mean mucosal visibility between the cases and controls was compared.

Results Mean mucosal visibility during UGIE was significantly better using NAC with simethicone as compared with no preparation at esophagus (1.14 [0.37] vs. 1.47 [0.62], p < 0.05), gastric fundus (1.10 [0.30] vs. 1.55 [0.64], p < 0.05), gastric body (1.22 [0.50] vs. 1.62 [0.73], p < 0.05), gastric antrum (1.13 [0.37] vs. 1.47 [0.62], p < 0.05), and duodenal bulb (1.13 [0.34] vs. 1.33 [0.56], p < 0.05). In distal duodenum, though visibility improved with NAC with simethicone, the difference was insignificant. There were no adverse events related to the pre-endoscopy drink.

Conclusion A pre-endoscopy drink of NAC with simethicone can significantly improve mucosal visibility during UGIE. It is safe, cheap, easily available and maybe considered for routine utilization for ensuring optimal endoscopic outcomes.

Keywords

endoscopic mucosal resection - endoscopic submucosal dissection - mucosal visibility - N-acetylcysteine - narrow band imaging - pre-endoscopy preparation - simethicone


Publication History

Article published online:
17 April 2021

© 2020. Society of Gastrointestinal Endoscopy of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Kastenberg D, Bertiger G, Brogadir S. Bowel preparation quality scales for colonoscopy. World J Gastroenterol 2018; 24 (26) 2833-2843
    CrossrefPubMedGoogle Scholar
  • 2 Faigel DO, Eisen GM, Baron TH. et al. Standards of Practice Committee. American Society for Gastrointestinal Endoscopy. Preparation of patients for GI endoscopy. Gastrointest Endosc 2003; 57 (04) 446-450
    CrossrefPubMedGoogle Scholar
  • 3 Bisschops R, Areia M, Coron E. et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2016; 48 (09) 843-864
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 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 (Suppl. 01) 2-15
    CrossrefPubMedGoogle Scholar
  • 5 Chen H-W, Hsu H-C, Hsieh T-Y, Yeh M-K, Chang W-K. Pre-medication to improve esophagogastroduodenoscopic visibility: a meta-analysis and systemic review. Hepatogastroenterology 2014; 61 (134) 1642-1648
    PubMedGoogle Scholar
  • 6 Tongprasert S, Sobhonslidsuk A, Rattanasiri S. Improving quality of colonoscopy by adding simethicone to sodium phosphate bowel preparation. World J Gastroenterol 2009; 15 (24) 3032-3037
    CrossrefPubMedGoogle Scholar
  • 7 Lee GJ, Park SJ, Kim SJ, Kim HH, Park MI, Moon W. Effectiveness of premedication with Pronase for visualization of the mucosa during endoscopy: a randomized, controlled trial. Clin Endosc 2012; 45 (02) 161-164
    CrossrefPubMedGoogle Scholar
  • 8 Elvas L, Areia M, Brito D, Alves S, Saraiva S, Cadime AT. Premedication with simethicone and N-acetylcysteine in improving visibility during upper endoscopy: a double-blind randomized trial. Endoscopy 2017; 49 (02) 139-145
    PubMedGoogle Scholar
  • 9 Neale JR, James S, Callaghan J, Patel P. Premedication with N-acetylcysteine and simethicone improves mucosal visualization during gastroscopy: a randomized, controlled, endoscopist-blinded study. Eur J Gastroenterol Hepatol 2013; 25 (07) 778-783
    CrossrefPubMedGoogle Scholar
  • 10 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 (04) 986-993
    CrossrefPubMedGoogle Scholar
  • 11 Chang W-K, Yeh M-K, Hsu H-C, Chen H-W, Hu M-K. Efficacy of simethicone and N-acetylcysteine as premedication in improving visibility during upper endoscopy. J Gastroenterol Hepatol 2014; 29 (04) 769-774
    CrossrefPubMedGoogle Scholar
  • 12 A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy - NICEVIS. - - NCBI [Internet]. [cited 2020 Apr 19]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=A+randomized+controlled+trial+of+pre-procedure+simethicone+and+N-acetylcysteine+to+improve+mucosal+visibility+during+gastroscopy+%E2%80%93+NICEVIS. Accessed December 8 2020
    PubMed
  • 13 Veeraraghavan K, Abel J, Shreyas V. et al. Efficacy of Simethicone and n-acetylcysteine combination premedication prior to esophagogastroduodenoscopy to improve mucosal visibility – a prospective double blinded randomized placebo controlled trial (CTRI/2017/09/009913). In: Endoscopy [Internet]. Georg Thieme Verlag KG; 2018 [cited 2020 Apr 25]. p. OP212. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1637249. Accessed December 8, 2020.
    Google Scholar
  • 14 Ali S, Zhou F, Braden B. et al. An objective comparison of detection and segmentation algorithms for artefacts in clinical endoscopy. Sci Rep 2020; 10 (01) 2748
    CrossrefPubMedGoogle Scholar
  • 15 The pathogenesis of bloating and visible distension in irritable bowel syndrome. - - NCBI [Internet]. [cited 2020 Apr 21]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15862934. Accessed December 8, 2020
  • 16 Corfield AP, Carroll D, Myerscough N, Probert CS. Mucins in the gastrointestinal tract in health and disease. Front Biosci 2001; 6: D1321-D1357
    CrossrefPubMedGoogle Scholar
  • 17 Kinoshita M, Igarashi S, Kume E, Saito N, Arakawa K. Fasting induces impairment of gastric mucosal integrity in non-insulin-dependent diabetic (db/db) mice. Aliment Pharmacol Ther 2000; 14 (03) 359-366
    CrossrefPubMedGoogle Scholar
  • 18 Brecević L, Bosan-Kilibarda I, Strajnar F. Mechanism of antifoaming action of simethicone. J Appl Toxicol 1994; 14 (03) 207-211
    CrossrefPubMedGoogle Scholar
  • 19 Song HJ. [Optimal bowel preparation for capsule endoscopy and device-assisted enteroscopy]. Korean J Gastroenterol 2020; 75 (02) 74-78
    CrossrefPubMedGoogle Scholar
  • 20 Hassan C, East J, Radaelli F. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - update 2019. Endoscopy 2019; 51 (08) 775-794
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Simethicone residue remains inside gastrointestinal endoscopes despite reprocessing. - - NCBI [Internet]. [cited 2020 Apr 21]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=simethicone+residue+remains+inside+despite+endoscope+reprocessing. Accessed December 8, 2020
  • 22 Simethicone use during gastrointestinal endoscopy: Position statement of the Gastroenterological Society of Australia - Devereaux - 2019 - Journal of Gastroenterology and Hepatology - Wiley Online Library [Internet]. [cited 2020 Apr 21]. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jgh.14757. Accessed December 8, 2020
  • 23 N-acetylcysteine as an adjuvant therapy for Helicobacter pylori eradication. - - NCBI [Internet]. [cited 2020 Apr 21]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30746681. Acces-sed December 8, 2020
  • 24 Endoscopic and enzymatic treatment of gastric bezoar with acetylcysteine. - - NCBI [Internet]. [cited 2020 Apr 21]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Endoscopic+and+enzymatic+treatment+of+gastric+bezoar+with+acetylcysteine.+Endoscopy+2002. Accessed December 8, 2020
  • 25 The add-on N-acetylcysteine is more effective than dimethicone alone to eliminate mucus during narrow-band imaging endoscopy: a double-blind, rando... - - NCBI [Internet]. [cited 2020 Apr 21]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=The+add-on+N-acetylcysteine+is+more+effective+than+dimethicone+alone+to+eliminate+mucus+during+narrow-band+imaging+endoscopy%3A+a+double-blind%2C+randomized+controlled+trial. Accessed December 8, 2020
  • 26 Mahawongkajit P, Kanlerd A. A prospective randomized controlled trial comparing simethicone, N-acetylcysteine, sodium bicarbonate and peppermint for visualization in upper gastrointestinal endoscopy. Surg Endosc. 2020
    PubMedGoogle Scholar
  • 27 Asl SMKH, Sivandzadeh GR. Efficacy of premedication with activated Dimethicone or N-acetylcysteine in improving visibility during upper endoscopy. World J Gastroenterol 2011; 17 (37) 4213-4217
    CrossrefPubMedGoogle Scholar
  • 28 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 (04) 218-228
    CrossrefPubMedGoogle Scholar
  • 29 Ahsan M, Babaei L, Gholamrezaei A, Emami MH. Simethicone for the preparation before esophagogastroduodenoscopy. Diagn Ther Endosc 2011; 2011: 484532
    CrossrefPubMedGoogle Scholar
  • 30 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; 66 (11) 1886-1899
    CrossrefPubMedGoogle Scholar