The Efficacy Of Defoam And Mucolytic Agent As Premedication In Improving Visibility During Upper Gastrointestinal Endoscopy

Background: Upper gastrointestinal(GI)endoscopy is one of the most common methods for the diagnosis and treatment of upper GI tract diseases and provides a unique opportunity to identify early neoplastic lesions.For optimum high-quality Esophagogastroduodenoscopy,good stomach and mucosal visualization is of extreme importance.However,foam,bubbles,and mucus often obstruct visibility and,additionally,can also increase the duration of the procedure,negatively influence the patient's tolerability and the performing endoscopist's satisfaction.Nowadays endoscopists use various premedication with the intension of reducing foam,bubbles and mucus during the endoscopy.Objective: The aim of this study is to evaluate the effectiveness of different premedication and theirs combined effects and safety in enhancing mucosal visibility during upper endoscopy.Methods: A single-center,prospective,double-blinded(patients and physician),randomized study.A total of 250 patients who referred to Zhongda Hospital affiliated to Southeast University,for undergoing elective outpatient and inpatient gastroscopy in gastroenterology unit.The participants were assigned randomly to receive one of five premedications: group A: simethicone,group B: simethicome plus pronase,group C: dimethicone,group D: dimethicone plus pronase and group E: pronase.15 to 30 minutes before endoscopy,the patients were presented with a premedication for the designated group.During the endoscopy mucosal visibility was assessed in the esophagus,gastric body and antrum,visibility scores were classified as 1–3: 1 = no and slight air bubbles(?25% bubbles)no adherent mucus and clear view of the mucosa;2 = moderate air bubbles(25%~50% bubbles)thin coating of mucus but not obscuring vision;and 3 = severe air bubbles(?50% bubbles)adherent mucus obscuring vision.Patients meeting the following criteria were excluded: Emergency cases,patients undergone previous total gastrectomy,gastrointestinal bleeding,had known neoplasia or stenosis,hypersensitivity to the trial medications,pregnant or breastfeeding women.Results: A total of 250 patients,122 male and 128 females,were enrolled in this study and,50 patients were randomly assigned to each of the 5 groups.There was no statistical significance between the groups in terms of age,sex and major procedure indications.Participants of Group E had a significantly lower total visibility score,in each area,than those in the other four groups(P < 0.05).Group C and D had higher total visibility scores in the esophagus,while group B and D had better overall visibility in the gastric body and the antrum.Conclusion: For an optimal visibility of UGI,free of excessive presence of bubble and mucus,is recommended the use of defoaming agent(simethicone or dimethicone)combined with a mucolytic agent(pronase)before upper gastrointestinal endoscopy.