Premedication in upper gastrointestinal endoscopy to improve mucosal visualization. A systematic review

Juan David Linares-Ramírez; Andrea Carolina Córdoba; Carlos Hernán Calderón-Franco; Diego Mauricio Aponte-Martín; Fabian Dávila; Luis Carlos Sabbagh

doi:10.47892/rgp.2024.444.1795

Autores/as

Juan David Linares-Ramírez Department of Gastroenterology and Endoscopy, Colombia University Clinic, Bogotá, Colombia. https://orcid.org/0000-0003-0926-4873
Andrea Carolina Córdoba Department of Gastroenterology and Endoscopy, Colombia University Clinic, Bogotá, Colombia. https://orcid.org/0000-0002-0527-2625
Carlos Hernán Calderón-Franco Department of Gastroenterology and Endoscopy, Colombia University Clinic, Bogotá, Colombia. https://orcid.org/0000-0002-9823-8409
Diego Mauricio Aponte-Martín Department of Gastroenterology and Endoscopy, Colombia University Clinic, Bogotá, Colombia. https://orcid.org/0000-0001-5901-7163
Fabian Dávila Department of Gastroenterology and Endoscopy, Colombia University Clinic, Bogotá, Colombia. https://orcid.org/0000-0002-1678-7288
Luis Carlos Sabbagh Department of Gastroenterology and Endoscopy, Colombia University Clinic, Bogotá, Colombia. https://orcid.org/0000-0002-5513-1425

DOI:

https://doi.org/10.47892/rgp.2024.444.1795

Palabras clave:

Premedication, Gastroscopy, Antifoaming Agents, Antiflatulents, Pronation, Simethicone, Dimethylpolysiloxanes, Cysteine

Resumen

Objective: This review aims to evaluate the efficacy and safety of premedication comprising mucolytics and/or defoaming agents to improve the quality of visualization during elective upper digestive endoscopy (elective upper GI endoscopy) procedure. Materials and methods: A systematic review of the literature contained in electronic databases (Medline/Pubmed, Embase, and Lilacs) was performed to identify randomized controlled trials and systematic reviews that assessed patients undergoing upper gastrointestinal endoscopy (elective upper GI Endoscopy) under sedation, after being premedicated with mucolytics and/or defoaming agents for mucous clearance. A meta-analysis was conducted to determine the relative efficacy and safety profile of such premedication. Results: In patients undergoing an elective procedure, premedication with defoaming and/or mucolytic agents improved the visibility score of the gastric antrum during upper GI endoscopy. The use of combined agents such as simethicone vs. water and N-acetyl cysteine (NAC) vs. water showed significant differences in favor of the active substance; however, no significant differences were found between the use of simethicone alone vs. simethicone + NAC. The use of pronase and dimethylpolysiloxane, among others, produced no significant difference (additive effect) in the visualization score. This is associated with the limited number of studies that performed similar comparisons and the heterogeneity of the outcomes. No major adverse effects were reported in the studies that were included regarding safety outcomes (i.e., volume of fluids required for clearance, risk of bronchoaspiration, and disinfection of equipment). Conclusions: The results of this review evidence that premedication with simethicone (a drug registered in Colombia for use against functional gastrointestinal disorders; ATC group A03A) is safe and effective for improving the quality of visualization during elective upper GI endoscopy procedures. However, no significant differences were observed in the visualization quality with the use or addition of other agents. The use simethicone should be set as off-label use and should be implemented at the prescriber’s discretion. The use of simethicone as a premedication is recommended to improve the endoscopic visualization score in elective procedures.

Descargas

Los datos de descargas todavía no están disponibles.

Métricas

Cargando métricas ...

Citas

Veitch AM, Uedo N, Yao K, East JE, Sajid MS, Rehman S, et al. Optimizing early upper gastrointestinal cancer detection at endoscopy. Nat Rev Gastroenterol Hepatol. 2018;12(11):660-7. doi: 10.1038/nrgastro.2015.128.

Sajid MS, Rehman S, Chedgy F, Singh KK. Improving the mucosal visualization at gastroscopy: a systematic review and meta-analysis of randomized, controlled trials reporting the role of Simethicone ± N-acetylcysteine. Transl Gastroenterol Hepatol. 2018;3:29. doi: 10.21037/tgh.2018.05.02.

Wang C, Liu H, Wang X, Shen X, Yang Y, Sun W, et al. Benefit of a 360-degree horizontal turn following premedication with simethicone on image quality during gastroendoscopy: a randomized controlled trial. Int J Clin Exp Med. 2015;8(3):4281-6.

Neale JR, James S, Callaghan J, Patel P. Premedication with N-acetylcysteine and simethicone improves mucosal visualization during gastroscopy: a randomized, controlled, endoscopistblinded study. Eur J Gastroenterol Hepatol. 2013;25(7):778-83. doi: 10.1097/MEG.0b013e32836076b2.

Royero Gutiérrez HA. Aplicación de una escala de visualización de la mucosa gástrica, durante la esofagogastroduodenoscopia en pacientes premedicados con N-acetilcisteína más simeticona: experiencia en Ocaña, Norte de Santander. Rev Colomb Gastroenterol. 2018;33(1):1-7. doi: 10.22516/25007440.226.

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(4):769-74. doi: 10.1111/jgh.12487.

Bertoni G, Gumina C, Conigliaro R, Ricci E, Staffetti J, Mortilla MG, et al. Randomized placebo-controlled trial of oral liquid simethicone prior to upper gastrointestinal endoscopy. Endoscopy. 1992;24(4):268-70. doi: 10.1055/s-2007-1010479.

Zhang L, Li W, Ji M, Liu F, Chen G, Wu S, et al. Efficacy and safety of using premedication with simethicone/Pronase during upper gastrointestinal endoscopy examination with sedation: A single center, prospective, single blinded, randomized controlled trial. Dig Endosc. 2018;30(1):57-64. doi: 10.1111/den.12952.

Liu X, Guan CT, Xue LY, He S, Zhang YM, Zhao DL, et al. Effect of premedication on lesion detection rate and visualization of the mucosa during upper gastrointestinal endoscopy: a multicenter large sample randomized controlled double-blind study. Surg Endosc. 2018;32(8):3548-56. doi: 10.1007/s00464-018-6077-4.

Keeratichananont S, Sobhonslidsuk A, Kitiyakara T, Achalanan N, Soonthornpun S. The role of liquid simethicone in enhancing endoscopic visibility prior to esophagogastroduodenoscopy (EGD): A prospective, randomized, double-blinded, placebo-controlled trial. J Med Assoc Thai. 2010;93(8):892-7.

Ahsan M, Babaei L, Gholamrezaei A, Emami MH. Simethicone for the Preparation before Esophagogastroduodenoscopy. Diagn Ther Endosc. 2011:2011:484532. doi: 10.1155/2011/484532.

Higgins JP, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. Wiley; 2008. doi: 10.1002/9780470712184.

L’ABBÉ KA. Meta-Analysis in Clinical Research. Ann Intern Med. 1987;107(2):224-33. doi: 10.7326/0003-4819-107-2-224.

Moore AR, Barden J, Derry S MH. Managing potential publication bias. In: McQuay HJ, Kalso E, Moore RA, editors. Systematic reviews in pain research: methodology refined. IASP Press, 2007.

Asl SMKH. Efficacy of premedication with activated Dimethicone or N-acetylcysteine in improving visibility during upper endoscopy. World J Gastroenterol. 2011;17(37):4213-7. doi: 10.3748/wjg.v17.i37.4213.

Kuo CH, Sheu BS, Kao AW, Wu CH, Chuang CH. A Defoaming Agent Should Be Used with Pronase Premedication to Improve Visibility in Upper Gastrointestinal Endoscopy. Endoscopy. 2002;34(7):531-4. doi: 10.1055/s-2002-33220.

Song M, Kwek ABE, Law NM, Ong JPL, Tan JY-L, Thurairajah PH, et al. Efficacy of small-volume simethicone given at least 30 min before gastroscopy. World J Gastrointest Pharmacol Ther. 2016;7(4):572-8. doi: 10.4292/wjgpt.v7.i4.572.

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(2):161-4. doi: 10.5946/ce.2012.45.2.161.

Basford P, Brown J, Gadeke L, Fogg C, Haysom-Newport B, Ogollah R, et al. A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy – NICEVIS. Endosc Int Open. 2016;4(11):E1197-202. doi: 10.1055/s-0042-117631.

Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 7. Rating the quality of evidence—inconsistency. J Clin Epidemiol. 2011;64(12):1294-302. doi: 10.1016/j.jclinepi.2011.03.017.

Guyatt G, Oxman AD, Sultan S, Brozek J, Glasziou P, Alonso-Coello P, et al. GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. J Clin Epidemiol. 2013;66(2):151-7. doi: 10.1016/j.jclinepi.2012.01.006.

Guyatt GH, Oxman AD, Santesso N, Helfand M, Vist G, Kunz R, et al. GRADE guidelines: 12. Preparing Summary of Findings tables—binary outcomes. J Clin Epidemiol. 2013;66(2):158-72. doi: 10.1016/j.jclinepi.2012.01.012.

Roberts I, Ker K, Edwards P, Beecher D, Manno D, Sydenham E. The knowledge system underpinning healthcare is not fit for purpose and must change. BMJ. 2015;350:h2463. doi: 10.1136/bmj.h2463.

McDonald GB, O’Leary R, Stratton C. Pre-endoscopic use of oral simethicone. Gastrointest Endosc. 1978;24(6):283. doi: 10.1016/S0016-5107(78)73542-X.

Devereaux BM, Taylor ACF, Athan E, Wallis DJ, Brown RR, Greig SM, et al. Simethicone use during gastrointestinal endoscopy: Position statement of the Gastroenterological Society of Australia. J Gastroenterol Hepatol. 2019;34(12):2086-9. doi: 10.1111/jgh.14757.

Wiffen PJ. The Cochrane Pain, Palliative and Supportive Care Group: current reviews and work in progress. Palliat Med. 2005;19(2):158-9. doi: 10.1191/0269216305pm999xx.

McNally MPR, Maydonovitch CL, Wong CRKH. The effectiveness of simethicone in improving visibility during colonoscopy: a double-blind randomized study. Gastrointest Endosc. 1988;34(3):255-8. doi: 10.1016/S0016-5107(88)71324-3.

Ofstead CL, Wetzler HP, Johnson EA, Heymann OL, Maust TJ, Shaw MJ. Simethicone residue remains inside gastrointestinal endoscopes despite reprocessing. Am J Infect Control. 2016;44(11):1237-40. doi: 10.1016/j.ajic.2016.05.016.

Monrroy H, Vargas JI, Glasinovic E, Candia R, Azúa E, Gálvez C, 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(4):986-93. doi: 10.1016/j.gie.2017.10.005.

Elvas L, Areia M, Brito D, Alves S, Saraiva S, Cadime A. Premedication with simethicone and N-acetylcysteine in improving visibility during upper endoscopy: a double-blind randomized trial. Endoscopy. 2016;49(2):139-45. doi: 10.1055/s-0042-119034.

Emura F, Sharma P, Arantes V, Cerisoli C, Parra-Blanco A, Sumiyama K, et al. Principles and practice to facilitate complete photodocumentation of the upper gastrointestinal tract: World Endoscopy Organization position statement. Dig Endosc. 2020;32(2):168-79. doi: 10.1111/den.13530.

Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71(3):446-54. doi: 10.1016/j.gie.2009.10.027.

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons; 2019.

Marcano B, Íñigo V, Sánchez Ramírez JM. Validación de rúbrica para evaluación de e-actividades diseñadas para el logro de competencias digitales docentes. Apunt Univ. 2020;10:115-29. doi: 10.17162/au.v10i2.451.

Raykov T. Alpha if item deleted: A note on loss of criterion validity in scale development if maximizing coefficient alpha. Br J Math Stat Psychol. 2008;61(Pt 2):275-85. doi: 10.1348/000711007X188520.

Higgins JPT. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-60. doi: 10.1136/bmj.327.7414.557.

Morgado FFR, Meireles JFF, Neves CM, Amaral ACS, Ferreira MEC. Scale development: ten main limitations and recommendations to improve future research practices. Psicol Reflexão e Crítica. 2018;30(1):3. doi: 10.1186/s41155-016-0057-1.