A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy – NICEVIS
Background and study aims: Mucosal views can be impaired by residual bubbles and mucus during gastroscopy. This study aimed to determine whether a pre-gastroscopy drink containing simethicone and N-acetylcysteine improves mucosal visualisation. Patients and methods: We conducted a randomi...
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Georg Thieme Verlag KG
2016-10-01
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Series: | Endoscopy International Open |
Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-117631 |
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doaj-18d2ff78aa0941e7aed9473abde388772020-11-25T02:31:40ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362016-10-010411E1197E120210.1055/s-0042-117631A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy – NICEVISPeter John Basford0James Brown1Lisa Gadeke2Carole Fogg3Ben Haysom-Newport4Reuben Ogollah5Rupam Bhattacharyya6Gaius Longcroft-Wheaton7Fergus Thursby-Pelham8James R. Neale9Pradeep Bhandari10Portsmouth Hospitals NHS trust – Endoscopy Portsmouth, Hampshire, United Kingdom of Great Britain and Northern IrelandUniversity of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern IrelandPortsmouth Hospitals NHS trust – Endoscopy Portsmouth, Hampshire, United Kingdom of Great Britain and Northern IrelandUniversity of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern IrelandUniversity of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern IrelandUniversity of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern IrelandPortsmouth Hospitals NHS Trust – Gastroenterology, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern IrelandPortsmouth Hospitals NHS trust – Endoscopy Portsmouth, Hampshire, United Kingdom of Great Britain and Northern IrelandPortsmouth Hospitals NHS trust – Endoscopy Portsmouth, Hampshire, United Kingdom of Great Britain and Northern IrelandSouth Devon Healthcare NHS Foundation Trust – Gastroenterology, Torquay, Torbay, United Kingdom of Great Britain and Northern IrelandPortsmouth Hospital – Endoscopy, Portsmouth, West Sussex, United Kingdom of Great Britain and Northern IrelandBackground and study aims: Mucosal views can be impaired by residual bubbles and mucus during gastroscopy. This study aimed to determine whether a pre-gastroscopy drink containing simethicone and N-acetylcysteine improves mucosal visualisation. Patients and methods: We conducted a randomized controlled trial recruiting 126 subjects undergoing routine gastroscopy. Subjects were randomized 1:1:1 to receive: A—pre-procedure drink of water, simethicone and N-acetylcysteine (NAC); B—water alone; or C—no preparation. Study endoscopists were blinded to group allocation. Digital images were taken at 4 locations (lower esophagus/upper gastric body/antrum/fundus), and rated for mucosal visibility (MV) using a 4-point scale (1 = best, 4 = worst) by 4 separate experienced endoscopists. The primary outcome measure was mean mucosal visibility score (MVS). Secondary outcome measures were procedure duration and volume of fluid flush required to achieve adequate mucosal views. Results: Mean MVS for Group A was significantly better than for Group B (1.35 vs 2.11, P < 0.001) and Group C (1.35 vs 2.21, P < 0.001). Mean flush volume required to achieve adequate mucosal views was significantly lower in Group A than Group B (2.0 mL vs 31.5 mL, P = 0.001) and Group C (2.0 mL vs 39.2 mL P < 0.001). Procedure duration did not differ significantly between any of the 3 groups. MV scores at each of the 4 locations demonstrated significantly better mucosal visibility in Group A compared to Group B and Group C (P < 0.0025 for all comparisons). Conclusions: A pre-procedure drink containing simethicone and NAC significantly improves mucosal visibility during gastroscopy and reduces the need for flushes during the procedure. Effectiveness in the lower esophagus demonstrates potential benefit in Barrett’s oesophagus surveillance gastroscopy.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-117631 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Peter John Basford James Brown Lisa Gadeke Carole Fogg Ben Haysom-Newport Reuben Ogollah Rupam Bhattacharyya Gaius Longcroft-Wheaton Fergus Thursby-Pelham James R. Neale Pradeep Bhandari |
spellingShingle |
Peter John Basford James Brown Lisa Gadeke Carole Fogg Ben Haysom-Newport Reuben Ogollah Rupam Bhattacharyya Gaius Longcroft-Wheaton Fergus Thursby-Pelham James R. Neale Pradeep Bhandari A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy – NICEVIS Endoscopy International Open |
author_facet |
Peter John Basford James Brown Lisa Gadeke Carole Fogg Ben Haysom-Newport Reuben Ogollah Rupam Bhattacharyya Gaius Longcroft-Wheaton Fergus Thursby-Pelham James R. Neale Pradeep Bhandari |
author_sort |
Peter John Basford |
title |
A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy – NICEVIS |
title_short |
A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy – NICEVIS |
title_full |
A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy – NICEVIS |
title_fullStr |
A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy – NICEVIS |
title_full_unstemmed |
A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy – NICEVIS |
title_sort |
randomized controlled trial of pre-procedure simethicone and n-acetylcysteine to improve mucosal visibility during gastroscopy – nicevis |
publisher |
Georg Thieme Verlag KG |
series |
Endoscopy International Open |
issn |
2364-3722 2196-9736 |
publishDate |
2016-10-01 |
description |
Background and study aims: Mucosal views can be impaired by residual bubbles and mucus during gastroscopy. This study aimed to determine whether a pre-gastroscopy drink containing simethicone and N-acetylcysteine improves mucosal visualisation.
Patients and methods: We conducted a randomized controlled trial recruiting 126 subjects undergoing routine gastroscopy. Subjects were randomized 1:1:1 to receive: A—pre-procedure drink of water, simethicone and N-acetylcysteine (NAC); B—water alone; or C—no preparation. Study endoscopists were blinded to group allocation. Digital images were taken at 4 locations (lower esophagus/upper gastric body/antrum/fundus), and rated for mucosal visibility (MV) using a 4-point scale (1 = best, 4 = worst) by 4 separate experienced endoscopists. The primary outcome measure was mean mucosal visibility score (MVS). Secondary outcome measures were procedure duration and volume of fluid flush required to achieve adequate mucosal views.
Results: Mean MVS for Group A was significantly better than for Group B (1.35 vs 2.11, P < 0.001) and Group C (1.35 vs 2.21, P < 0.001). Mean flush volume required to achieve adequate mucosal views was significantly lower in Group A than Group B (2.0 mL vs 31.5 mL, P = 0.001) and Group C (2.0 mL vs 39.2 mL P < 0.001). Procedure duration did not differ significantly between any of the 3 groups. MV scores at each of the 4 locations demonstrated significantly better mucosal visibility in Group A compared to Group B and Group C (P < 0.0025 for all comparisons).
Conclusions: A pre-procedure drink containing simethicone and NAC significantly improves mucosal visibility during gastroscopy and reduces the need for flushes during the procedure. Effectiveness in the lower esophagus demonstrates potential benefit in Barrett’s oesophagus surveillance gastroscopy. |
url |
http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-117631 |
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