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[Other] Premedication with simethicone and n-acetylcysteine for improving mucosal visibility during upper gastrointestinal endoscopy: A randomized controlled trial

2286742404 Post time Half hour(s) ago | Show all posts |Read mode
This post will be closed automatically in 2026-08-24 16:33
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Background and Aim: Diagnostic performance of esophagogastroduodenoscopy may be compromised due to adherent mucus and foam. In this study we aimed to assess the impact of pre-medication on mucosal visibility during endoscopy. Methods This is a double-blinded, randomized trial conducted at a tertiary care centre. Patients were randomized into four groups: A (water), B (simethicone [S]), C(N-acetyl cysteine [NAC]); D(S+NAC). Premedication solutions were administered 10-30 min before endoscopy and mucosal visibility graded from 1 to 4 (1 best, 4 worst). Total mucosal visibility scores (TMVS) were analyzed and compared. Primary outcome of study was comparison of TMVS between simethicone and combination (S+NAC). Secondary outcomes were adverse events and impact of endoscopy timing on TMVS. Results Eight hundred patients (39 y, 68.8% males) were randomized into four groups. TMVS were significantly lower in groups-B (7 [6-8]) and D(8 [6-9]) as compared to A and C. There was no difference in TMVS in groups-A and C (p=0.137). TMVS were significantly lower in late (>20-30 min) versus early (10-20 min) endoscopy sub-group (p=0.001). However, TMVS were similar between group-B and group-D in early endoscopy group (p=0.451). Conclusions Pre-medication with simethicone or combination (simethicone and NAC) significantly improves mucosal visibility. If early endoscopy is indicated, simethicone provides similar mucosal visibility and may be an effective alternative to combined pre-medication.
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