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A prospective randomized controlled trial comparing simethicone, N-acetylcysteine, sodium bicarbonate and peppermint for visualization in upper gastrointestinal endoscopy

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Abstract

Objectives

Early cancer detection is crucial in improving the patients’ quality of life and upper gastrointestinal endoscopy (EGD) plays a key role in this detection. Many clearing mechanisms may be applied to create good endoscopic visualizations for the upper gastrointestinal tract using mucolytic agents, antifoaming agents, proteolytic enzymes and neutralizers. The aim of this study is to compare the effects of simethicone, N-acetylcysteine (NAC), sodium bicarbonate and peppermint as pre-medications for visualization of esophagogastroduodenoscopy (EGD).

Methods

This study was a single center prospective randomized controlled trial. The patients were randomly allocated to one of four treatment groups. Group A: water; Group B: water with simethicone; Group C: water with simethicone plus NAC 600 mg; Group D: water with simethicone, NAC, sodium bicarbonate and peppermint.

Results

A total of 128 patients were enrolled and evaluated in this study. Total visibility score (TVS) of Groups A, B, C, and D were 13.4 ± 1.86, 10.5 ± 1.45, 7.15 ± 0.98 and 6.4 ± 1.43, respectively. Group D showed lower TVS than other groups. The procedural durations of Groups C and D were significantly shorter than Group A. The volume of solution for mucosal cleansing of Groups C and D was significantly lower than Groups A and B.

Conclusions

The application of simethicone plus NAC is safe, improves endoscopic visualization and requires a minimal amount of mucosal cleansing solution. The addition of sodium bicarbonate and peppermint further improved visualization for the upper and lower gastric body.

Thai Clinical Trials Registry (TCTR) with a reference number; TCTR20190501002.

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Acknowledgements

The authors would like to thank Norman Mangnall for assistance in editing the English version of this manuscript and Dr. Saritphat Orrapin for scrutinizing methodology and for statistical consultation.

Funding

This research was supported by Faculty of Medicine, Thammasat University.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 99/209 Moo 18, Paholyothin Road, Amphur Klongluang, Pathumthani, 12120, Thailand

    Prasit Mahawongkajit & Amonpon Kanlerd

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  1. Prasit Mahawongkajit
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  2. Amonpon Kanlerd
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Correspondence to Prasit Mahawongkajit.

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Dr. Prasit Mahawongkajit and Dr. Amonpon Kanlerd have no conflicts of interest.

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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 35, 303–308 (2021). https://doi.org/10.1007/s00464-020-07397-8

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  • DOI: https://doi.org/10.1007/s00464-020-07397-8

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