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Beaufort I, Verbeek R, Bosman J, Al-Toma A, Bogte A, Alvarez Herrero L, Weusten B. Optimal timing of simethicone administration prior to upper endoscopy: A multicenter, single-blind, randomized controlled trial. Endosc Int Open 2023; 11:E992-E1000. [PMID: 37854124 PMCID: PMC10581826 DOI: 10.1055/a-2157-5034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/25/2023] [Indexed: 10/20/2023] Open
Abstract
Background and study aims Simethicone is useful as premedication for upper endoscopy because of its antifoaming effects. We aimed to evaluate the effect of timing of simethicone administration on mucosal visibility. Patients and methods In this multicenter, randomized, endoscopist-blinded study, patients scheduled for upper endoscopy were randomized to receive 40 mg simethicone at the following time points prior to the procedure: 20 to 30 minutes (early group), 0 to 10 minutes (late group) or 20 mg simethicone at both time points (split-dose group). Images were taken from nine predefined locations in the esophagus, stomach, and duodenum before endoscopic flushing. Each image was scored on mucosal visibility by three independent endoscopists on a 4-point scale (lower scores indicating better visibility), with adequate mucosal visibility defined as a score ≤ 2. Primary outcome was the percentage of patients with adequate total mucosal visibility (TMV), reached if all median subscores for each location were ≤ 2. Results A total of 386 patients were included (early group: 132; late group: 128; split-dose group: 126). Percentages of adequate TMV were 55%, 42%, and 61% in the early, late, and split-dose group, respectively ( P < 0.01). Adequate TMV was significantly higher in the split-dose group compared to the late group ( P < 0.01), but not compared to the early group ( P = 0.29). Differences between groups were largest in the stomach, where percentages of adequate mucosal visibility were higher in the early (68% vs 53%, P = 0.03) and split-dose group (69% vs 53%, P = 0.02) compared to the late group. Conclusions Mucosal visibility can be optimized with early simethicone administration, either as a single administration or in a split-dose regimen.
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Affiliation(s)
- I.N. Beaufort
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R.E. Verbeek
- Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, the Netherlands
| | - J.H. Bosman
- Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, the Netherlands
| | - A. Al-Toma
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - A. Bogte
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L. Alvarez Herrero
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - B.L.A.M. Weusten
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
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Tjandra D, Busuttil RA, Boussioutas A. Gastric Intestinal Metaplasia: Challenges and the Opportunity for Precision Prevention. Cancers (Basel) 2023; 15:3913. [PMID: 37568729 PMCID: PMC10417197 DOI: 10.3390/cancers15153913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
GIM is a persistent, premalignant lesion whereby gastric mucosa is replaced by metaplastic mucosa resembling intestinal tissue, arising in the setting of chronic inflammation, particularly in the context of Helicobacter pylori. While the overall rates of progression to gastric adenocarcinoma are low, estimated at from 0.25 to 2.5%, there are features that confer a much higher risk and warrant follow-up. In this review, we collate and summarise the current knowledge regarding the pathogenesis of GIM, and the clinical, endoscopic and histologic risk factors for cancer. We examine the current state-of-practice with regard to the diagnosis and management of GIM, which varies widely in the published guidelines and in practice. We consider the emerging evidence in population studies, artificial intelligence and molecular markers, which will guide future models of care. The ultimate goal is to increase the detection of early gastric dysplasia/neoplasia that can be cured while avoiding unnecessary surveillance in very low-risk individuals.
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Affiliation(s)
- Douglas Tjandra
- Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, VIC 3004, Australia;
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Rita A. Busuttil
- Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, VIC 3004, Australia;
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Alex Boussioutas
- Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, VIC 3004, Australia;
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia
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Fuentes-Valenzuela E, Pérez-Arenas E, de Benito Sanz M, Chavarría C, Miguel Peña A, Carbajo López A, Tejedor-Tejada J, Burgueño Gómez B, Sánchez-Ocaña R, Albillos-Blanco M, Salvador de Las Heras A, García-Alonso FJ. Prospective cohort study to evaluate premedication with simethicone and n-acetilcysteine for upper diagnostic gastrointestinal endoscopy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:10-15. [PMID: 35297256 DOI: 10.17235/reed.2022.8576/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The use of premedication for upper gastrointestinal endoscopy (UGE) is not widely established in western countries. The primary aim of the study was to compare gastric visibility according to the total visibility score (TVS). The secondary aim was to assess complications, diagnostic yield, endoscopic procedure time, sedation dose and patient satisfaction. METHODS A single center prospective cohort study was performed of consecutive adults undergoing an UGE in the afternoon working shift. After completing enrolment in the control group, patients were administered 200 mg simethicone and 500 mg N-acetylcysteine diluted in 100 ml of water >15 minutes before the procedure. All procedures were recorded and a single, blinded endoscopist evaluated the TVS after recruitment of both cohorts. Patient satisfaction was evaluated using the Spanish translation of the American Society of Gastrointestinal Endoscopy satisfaction questionnaire. RESULTS 205 patients were included in the study, 103 females (50.2%) with a median age of 54.8-years (IQR: 41.2-65.2). 104 were enrolled to the control group and 101 to the intervention group. Patients receiving premedication presented a higher rate of adequate (74.3% vs 45.2; difference 95% CI: 16,3-41,9%, p<0.001) and excellent gastric visibility (23.8% vs 7.7%; difference 95% CI: 6,3-25,8%, p=0.002). Propofol dose was similar, although the median procedure time was lower in the group of no intervention [5 (IQR: 4-7) vs 6 minutes (IQR: 5-7); p=0.03]. Procedure related adverse events were similar, except that patient without premedication experienced more nausea episodes. Major and minor endoscopic findings and the satisfaction questionnaire showed no differences between both groups. CONCLUSION Patients receiving premedication with simethicone and N-acetylcysteine had a better gastric visibility score, without any increase in adverse events or affecting the patients' satisfaction.
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Affiliation(s)
| | | | - Marina de Benito Sanz
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Río Hortega, Spain
| | - Carlos Chavarría
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Río Hortega, Spain
| | - Aleida Miguel Peña
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Río Hortega, Spain
| | - Ana Carbajo López
- Endoscopy Unit, Gastroenterology department. , Hospital Universitario Río Hortega, Spain
| | - Javier Tejedor-Tejada
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Río Hortega, Spain
| | | | - Ramon Sánchez-Ocaña
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Río Hortega, Spain
| | - María Albillos-Blanco
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario Río Hortega, Spain
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Duez L, Gkolfakis P, Bastide M, Vuckovic C, Musala C, Van Gossum M, Hoyois A, Mulkay JP, Eisendrath P. Premedication with simethicone for improving the quality of gastric mucosal visualization: a double-blind randomized controlled trial. Endosc Int Open 2022; 10:E1343-E1349. [PMID: 36262507 PMCID: PMC9576330 DOI: 10.1055/a-1922-7773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background and study aims Saliva, bubbles, or mucus can limit gastric mucosal visualization (GMV), increasing the risk of missed lesions such as gastric cancer. Several studies using endoscopy photodocumentation-based scores have reported increased quality of GMV when mucolytic and/or defoaming agents are administered. This single-center, prospective, double-blind, randomized, placebo-controlled trial aimed to evaluate whether simethicone administration could improve GMV. Patients and methods Patients were randomly assigned (1:1) to receive either 200 mg of simethicone (Group A) or placebo (Group B). Two independent endoscopists reviewed the entire video recording from each examination to assess the quality of GMV. The primary outcome was the rate of adequate GMV, defined as the percentage of patients in each group with a video score scale < 7 based on gastric visualization of five gastric landmarks. Secondary outcomes included procedure duration, patient satisfaction, and side effects. Results A total of 110 consecutive outpatients were randomly assigned to one of the two study groups (11 were excluded for various reasons). For the primary endpoint, 32 patients (61.5 %) in group A achieved adequate GMV compared to one of 47 (2.1 %) in group B (odds ratio [95 % confidence interval]: 73.6 [9.4-576.6]; P < 0.001). Median procedure time did not differ between the groups ( P = 0.55), and no differences were detected in patient satisfaction ( P = 0.18) or side effects ( P = 0.58). No serious adverse events were documented. Conclusions Premedication with simethicone before upper gastrointestinal endoscopy significantly improves the quality of GMV without affecting the duration of the examination, patient satisfaction, and the rate of side effects.
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Affiliation(s)
- Leo Duez
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Paraskevas Gkolfakis
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Marine Bastide
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Clemence Vuckovic
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Carmen Musala
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Van Gossum
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Alice Hoyois
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Pierre Mulkay
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Eisendrath
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
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van Noort HHJ, Lamers CR, Vermeulen H, Huisman-de Waal G, Witteman BJM. Patient Education Regarding Fasting Recommendations to Shorten Fasting Times in Patients Undergoing Esophagogastroduodenoscopy: A Controlled Pilot Study. Gastroenterol Nurs 2022; 45:342-353. [PMID: 35856722 PMCID: PMC9514738 DOI: 10.1097/sga.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/31/2022] [Indexed: 11/25/2022] Open
Abstract
This study evaluated the applicability and efficacy of patient education regarding fasting recommendations to shorten fasting times in patients undergoing esophagogastroduodenoscopy (EGD). A prospective nonrandomized controlled pilot study was performed. The intervention group (IG) was educated by nurses to eat until 6 hours and drink until 2 hours before EGD. The control group (CG) received usual care. Outcomes were applicability as perceived by patients, adherence to fasting recommendations, gastric visibility, and patients' comfort. A total of 109 patients were included of whom 42 were IG patients (37%). Patients' perspectives on fasting, their experienced discomfort, professional support, and circadian rhythm influenced application of fasting recommendations. Adherence to length of fasting from foods improved with 3:14 hours ( p < .001) and from liquids with 5:22 hours ( p < .001) in the IG compared with the CG. Gastric visibility during EGD was better in the IG than in the CG. The IG patients experienced significant less thirst, hunger, headache, and anxiety. To successfully reduce fasting times, fasting education should include positive, individual instructions, which help patients apply the fasting recommendations within their biorhythm. Positive, concrete instructions by nurses shortened fasting times before EGD, which improved gastric visibility and reduced patient discomfort.
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Affiliation(s)
- Harm H. J. van Noort
- Correspondence to: Harm H. J. van Noort, MSc, RN, Department of Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands ()
| | - Carlijn R. Lamers
- Harm H. J. van Noort, MSc, RN, is from the Departments of Nutrition, Physical Activity and Sports, and Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Carlijn R. Lamers, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Hester Vermeulen, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Getty Huisman-de Waal, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Ben J. M. Witteman, PhD, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Hester Vermeulen
- Harm H. J. van Noort, MSc, RN, is from the Departments of Nutrition, Physical Activity and Sports, and Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Carlijn R. Lamers, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Hester Vermeulen, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Getty Huisman-de Waal, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Ben J. M. Witteman, PhD, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Getty Huisman-de Waal
- Harm H. J. van Noort, MSc, RN, is from the Departments of Nutrition, Physical Activity and Sports, and Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Carlijn R. Lamers, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Hester Vermeulen, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Getty Huisman-de Waal, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Ben J. M. Witteman, PhD, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Ben J. M. Witteman
- Harm H. J. van Noort, MSc, RN, is from the Departments of Nutrition, Physical Activity and Sports, and Surgery, Gelderse Vallei Hospital, Ede, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Carlijn R. Lamers, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Hester Vermeulen, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Getty Huisman-de Waal, PhD, RN, is from the Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; and Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Ben J. M. Witteman, PhD, MD, is from the Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands; and Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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Can Chromoendoscopy Improve the Early Diagnosis of Gastric Carcinoma in Dogs? Animals (Basel) 2022; 12:ani12172253. [PMID: 36077972 PMCID: PMC9454935 DOI: 10.3390/ani12172253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2022] Open
Abstract
Simple Summary Currently, canine gastric carcinoma is mainly diagnosed in its late, incurable phase, and strategies for early diagnosis are lacking. In human medicine, chromoendoscopic (CE) methods such as staining the gastric mucosal surface with indigo carmine (IC), and narrow band imaging (NBI), have improved the diagnosis of precancerous gastric mucosal changes and early gastric carcinoma. This study aimed at investigating whether IC-CE and NBI-CE can improve the diagnostic yield of endoscopy in dogs. Belgian Shepherd dogs are predisposed to gastric carcinoma; thus, 30 dogs of the breed served as the study population. As a result, the study revealed that especially the combination of standard white light endoscopy (WLE) with NBI-CE allows better recognition of gastric mucosal structural changes than WLE alone. However, CE assessment templates used to predict the type of mucosal change in humans were not applicable in dogs. The value of the study lies in providing evidence that CE can improve the diagnosis of precancerous changes and early gastric carcinoma in dogs. However, current image assessment templates from human medicine need major adjustments to comprehend canine gastric mucosal conditions. Abstract Chromoendoscopy has improved the early diagnosis of gastric cancer in humans but its usefulness in dogs is unknown. This study aimed at assessing whether adding narrow band imaging (NBI) or indigo carmine (IC) chromoendoscopy (CE) can improve the diagnostic yield of standard white light endoscopy (WLE). We compared the real-time findings of canine WLE, NBI-CE, and IC-CE and corresponding histology reports with endoscopic mucosal pattern assessment templates used in human medicine. Belgian Shepherd dogs are predisposed to gastric carcinoma. Therefore, 30 dogs of this breed served as the study population. According to histology, 17/30 dogs had mucosal changes (mucous metaplasia, glandular dysplasia, and gastric carcinoma). Diagnostic yield was best when targeted biopsies were taken with WLE and NBI-CE combined (15/17 cases). WLE alone positively identified only 8/17 cases and missed a gastric carcinoma in 3/6 cases. CE assessment templates based on macroscopic mucosal patterns, broadly used in human medicine, were not readily applicable in dogs. In conclusion, the study provides evidence that using CE in dogs has the potential to improve the diagnosis of precancerous gastric mucosal pathology and early gastric carcinoma. However, current image assessment templates from human medicine need major adjustments to the patterns of canine gastric mucosa.
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Romańczyk M, Ostrowski B, Kozłowska-Petriczko K, Pawlak KM, Kurek K, Zatorski H, Koziej M, Romańczyk T, Wosiewicz P, Marek T, Wiechowska-Kozłowska A, Małecka-Panas E, Hartleb M. Scoring system assessing mucosal visibility of upper gastrointestinal tract: The POLPREP scale. J Gastroenterol Hepatol 2022; 37:164-168. [PMID: 34397116 DOI: 10.1111/jgh.15662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/20/2021] [Accepted: 08/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM The proper visibility of mucosa during esophagogastroduodenoscopy (EGD) is crucial for the detection of early upper gastrointestinal tract lesions. In contrast to colonoscopy, no validated scoring system for the assessment of upper gastrointestinal mucosal cleanliness has been developed so far. The aim of the study was to create and validate standardized grading system (POLPREP) to assess the mucosal cleanliness during EGD. METHODS To assess the visibility of mucosa during EGD, 4-point scale was developed (0-3). Twelve operators assessed 18 images of esophagus, stomach, and duodenum twice (in 2 weeks interval). In validation round, the images and endoscopy reports of 443 EGDs performed in six centers were assessed. RESULTS The inter-observer accordance of POLPREP was 0.8 (intra-class correlation coefficient; 0.79 consultants, 0.85 trainees). The intra-observer repeatability was 0.64 (Fleiss kappa value; 0.64 consultants, 0.64 trainees). The lesions detection rate was significantly higher in clean (scores 2 and 3; 19.7%) than in "unclean" segments (score 1; 7.7%, P = 0.049). Score 3 was associated with over three-fold higher lesion detection than score 1 (odds ratio 3.2, 95% confidence interval 1.1-9; P = 0.03). CONCLUSIONS The proposed POLPREP scale allows for unified assessment of upper gastrointestinal tract mucosal cleanliness. The higher cleanliness scores are related with greater upper gastrointestinal pathologies detection.
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Affiliation(s)
- Marcin Romańczyk
- Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.,Endotherapy, H-T. Medical Center, Tychy, Poland
| | - Bartosz Ostrowski
- Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Katarzyna M Pawlak
- Department of Gastroenterology, Endoscopy Unit, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
| | - Krzysztof Kurek
- Department of Gastroenterology and Internal Medicine, Medical University of Białystok, Białystok, Poland
| | - Hubert Zatorski
- Department of Digestive Tract Diseases, Medical University of Łódź, Łódź, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Piotr Wosiewicz
- Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz Marek
- Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Ewa Małecka-Panas
- Department of Digestive Tract Diseases, Medical University of Łódź, Łódź, Poland
| | - Marek Hartleb
- Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Sun X, Xu Y, Zhang X, Ma C, Li A, Yu H, Zhang W, Zhang H, Yang T, Miao X, Zhang H, Liu Y, Lu Z. Simethicone administration improves gastric cleanness for esophagogastroduodenoscopy: a randomized clinical trial. Trials 2021; 22:555. [PMID: 34419109 PMCID: PMC8379843 DOI: 10.1186/s13063-021-05527-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/09/2021] [Indexed: 12/16/2022] Open
Abstract
Background Esophagogastroduodenoscopy is very useful in diagnosing and treating upper gastrointestinal mucosal disorders, but too much foam and water in stomach decrease its diagnostic efficiency. Simethicone administration can help remove excessive foam. Aims To determine the optimal simethicone administration strategies in a comparative randomized controlled clinical trial. Methods Adult outpatients with indications for esophagogastroduodenoscopy were enrolled and randomly divided into group 1 (simethicone solution intake 20–30 min before procedure, n = 110), group 2 (simethicone solution intake 31–60 min before procedure, n = 92), and group 3 (simethicone solution intake > 60 min before procedure). Primary and secondary outcomes were procedure time and the patients’ satisfaction after the examination. All symptoms like abdominal pain and distension were recorded. Results No statistically significant differences were found on the patients’ demographic and clinical features and mean examination time (all P values > 0.05). The distribution of patients with different endoscopic and pathological diagnosis was comparable among three groups, respectively (P = 0.607; P = 0.289). However, the proportion of patients with Gastric Cleanness Grade A was most in group 2 (n = 73, 79.3%), and patient proportion with Gastric Cleanness Grade C was most found in group 1 (n = 72, 65.5%), which was greatly different (P < 0.001). There was no statistically significant difference on the satisfaction scores [immediately 6 (3–8) vs. 6 (1–10) vs. 6 (1-9), P = 0.533; 2 h after 10 (8–10) vs. 10 (10–10) vs. 10 (8-10), P = 0.463]. Conclusion Simethicone solution intake 31–60 min before esophagogastroduodenoscopy can help obtain the best gastric cleanness, which is recommended in clinical practice (registered at ClinicalTrials.gov, NCT03776916 on December 13, 2018).
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Affiliation(s)
- Xiaotian Sun
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China.,Department of Internal Medicine, Beijing South Medical District, Chinese PLA General Hospital, Beijing, 100161, China
| | - Yang Xu
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Xueting Zhang
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Cuiyun Ma
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Aitong Li
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Haiyan Yu
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Weihua Zhang
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Hanqing Zhang
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Teng Yang
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Xinfang Miao
- Clinic of Fuxing Road, Beijing South Medical District, Chinese PLA General Hospital, Beijing, 100161, China
| | - Huiming Zhang
- Clinic of Fuxing Road, Beijing South Medical District, Chinese PLA General Hospital, Beijing, 100161, China
| | - Yan Liu
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Zheng Lu
- Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, No. 100 Middle Road in Fourth West Ring, Beijing, 100039, China.
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Does Premedication with Mucolytic Agents Improve Mucosal Visualization during Oesophagogastroduodenoscopy: A Systematic Review and Meta-Analysis. Surg Res Pract 2021; 2021:1570121. [PMID: 33553573 PMCID: PMC7846405 DOI: 10.1155/2021/1570121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/21/2020] [Accepted: 10/26/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Gastric Cancer (GC) is the fourth most common malignancy worldwide and the second leading cause of cancer-related mortality for both sexes. The gold standard for diagnosing GC is oesophagogastroduodenoscopy (OGD). Excess mucus on the gastric mucosa impairs the detection of early GC. Aim To synthesize available evidence of the effect of premedication with a mucolytic agent among adults undergoing elective nontherapeutic OGD, compared to placebo or other mucolytic agents, on mucosal visibility during OGD. Methods A systematic review was conducted. PubMed, EMBASE, CINAHL, Cochrane central register of controlled trials (CENTRAL), and Web of Science were searched for relevant studies. A random-effects meta-analysis was performed to determine the mean difference in total mucosal visibility score (TMVS) between the pooled mucolytic agents and control. Subgroup analyses were performed to determine the mean TMVS difference for simethicone versus control and the impact of different timings and doses of mucolytic premedication. Results 13 studies, involving 11,086 patients, including 6178 females (55.7%), with a mean age of 53.4 were identified and 6 of these were brought forward to meta-analysis. This revealed a mean difference of -2.69 (95% CI -3.5, -1.88) in total mucosal visibility scores (TMVS) between the pooled mucolytic agents and control. For simethicone, the mean difference was -2.68 (95% CI -4.94, -0.43). A simethicone dose of 133 mg was most effective with a mean difference of -4.22 (95% CI -5.11, -3.33). Assessing timing of administration across all mucolytic agents revealed a mean difference for the >20 minutes group of -3.68 (95% CI -4.77, -2.59). No adverse events were reported in any included trials. Conclusions Regular use of premedication with mucolytic agents prior to routine OGD is associated with improved TMVS with no reported adverse events.
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Manfredi G, Bertè R, Iiritano E, Alicante S, Londoni C, Brambilla G, Romeo S, Menozzi F, Griffanti P, Brandi G, Moreschi O, Pezzilli R, Zullo A, Buscarini E. Premedication with simethicone and N-acetylcysteine for improving mucosal visibility during upper gastrointestinal endoscopy in a Western population. Endosc Int Open 2021; 9:E190-E194. [PMID: 33532557 PMCID: PMC7834924 DOI: 10.1055/a-1315-0114] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023] Open
Abstract
Background and study aim Pre-endoscopic use of a preparation with tensioactive and mucolytic agents improved gastric mucosa visualization in Eastern studies. Data on Western population are scanty. Patients and methods This prospective, endoscopist-blinded, randomized study enrolled patients who underwent esophagogastroduodenoscopy in a single center. Before endoscopy patients, were randomized to receive or not receive an oral preparation with simethicone and N-acetylcysteine in water. A pretested score (Crema Stomach Cleaning Score [CSCS]) for gastric mucosa cleaning evaluation was used. In detail, the stomach was divided into the antrum, body, and fundus and a score of 1 to 3 was assigned to each part (the higher the score, the better the preparation), and a total value ≤ 5 was considered as insufficient. Time between endoscope insertion and clean achievement (mouth to clean time) or the end of examination (mouth to mouth time) was recorded. Results A total of 197 patients were enrolled. The mean overall CSCS value and mucosal cleaning in all parts was better in treated patients than in controls. Prevalence total score ≤ 5 was significantly lower in patients treated before endoscopy. Need for water flush occurred less frequently in treated patients ( P < 0.0001). The mouth to clean time was lower in the treated than in the control group (2.3 ± 1.6 vs 3.8 ± 1.6 min; P < 0.001), whereas no significant difference in mouth to mouth time emerged. Conclusions Data from this study show that premedication with simethicone and N-acetylcysteine results in significantly better endoscopic visualization of gastric mucosa, and the proposed CSCS could be useful for standardizing this evaluation.
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Affiliation(s)
- Guido Manfredi
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Roberto Bertè
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy,Gastroenterology and Endoscopy Department, ‘Ca’ Granda’ Hospital, Milan, Italy
| | - Elena Iiritano
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Saverio Alicante
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Claudio Londoni
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Giancarlo Brambilla
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Samanta Romeo
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Fernanda Menozzi
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Paola Griffanti
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Giovanna Brandi
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | - Oliva Moreschi
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
| | | | - Angelo Zullo
- Gastroenterology, ‘Nuovo Regina Margherita’ Hospital, Rome, Italy
| | - Elisabetta Buscarini
- Gastroenterology and Endoscopy Department, ASST Crema Maggiore Hospital, Crema, Italy
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11
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Zuberi BF, Shaikh MA, Ali FS, Rasheed T, Nawaz Z. Effect of pre-endoscopy intake of simethicone solution on endoscopic mucosal visibility: A single blinded, placebo control, randomized trial. Pak J Med Sci 2020; 36:172-176. [PMID: 32063954 PMCID: PMC6994877 DOI: 10.12669/pjms.36.2.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine effect of pre-endoscopy intake of simethicone solution on endoscopic mucosal visibility. Methodology: A randomized, single blinded placebo control trial was done in patients undergoing oesophago-gastro-duodenoscopy for any indication at DOTs Endoscopy Suite, CHK during the period of April to June 2019. Informed consent was taken. Patients were randomly allocated in two groups. Group-A received placebo while Group-B received Simethicone. Evaluation of mucosal visibility was assessed at 4 sites (oesophagus, fundus, antrum & duodenum) by previously validated scoring. Mean of visibility scores were compared in two groups. Results: Two hundred and forty-eight patients were inducted and randomly allocate to two groups of 124 each. Mean of total sum of scores in Group-A was 8.14 ±2.44 and that of Group-B was 5.80 ±1.75 (p<0.001). Adequate visibility in Group-A was seen in 41.1% and that in Group-B was 78.2% (p<0.001). Conclusion: Use of Simethicone significantly improves mucosal visibility during OGD.
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Affiliation(s)
- Bader Faiyaz Zuberi
- Bader Faiyaz Zuberi, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Majid Ahmed Shaikh
- Majid Ahmed Shaikh, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Faiza Sadaqat Ali
- Faiza Sadaqat Ali, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Tazeen Rasheed
- Tazeen Rasheed, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Zunaira Nawaz
- Zunaira Nawaz Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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12
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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 2020; 35:303-308. [PMID: 32016519 DOI: 10.1007/s00464-020-07397-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/28/2020] [Indexed: 12/24/2022]
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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Affiliation(s)
- Prasit Mahawongkajit
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 99/209 Moo 18, Paholyothin Road, Amphur Klongluang, Pathumthani, 12120, Thailand.
| | - Amonpon Kanlerd
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 99/209 Moo 18, Paholyothin Road, Amphur Klongluang, Pathumthani, 12120, Thailand
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13
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Devereaux BM, Taylor ACF, Athan E, Wallis DJ, Brown RR, Greig SM, Bailey FK, Vickery K, Wardle E, Jones DM. Simethicone use during gastrointestinal endoscopy: Position statement of the Gastroenterological Society of Australia. J Gastroenterol Hepatol 2019; 34:2086-2089. [PMID: 31242327 DOI: 10.1111/jgh.14757] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 12/13/2022]
Abstract
Concern has been raised regarding the use of simethicone, a de-foaming agent, during endoscopic procedures. Following reports of simethicone residue in endoscope channels despite high level disinfection, an endoscope manufacturer recommended that it not be used due to concerns of biofilm formation and a possible increased risk of microorganism transmission. However, a detailed mucosal assessment is essential in performing high-standard endoscopic procedures. This is impaired by bubbles within the gastrointestinal lumen. The Gastroenterological Society of Australia's Infection Control in Endoscopy Guidelines (ICEG) Committee conducted a literature search utilizing the MEDLINE database. Further references were sourced from published paper bibliographies. Following a review of the available evidence, and drawing on extensive clinical experience, the multidisciplinary ICEG committee considered the risks and benefits of simethicone use in formulating four recommendations. Published reports have documented residual liquid or crystalline simethicone in endoscope channels after high level disinfection. There are no data confirming that simethicone can be cleared from channels by brushing. Multiple series report benefits of simethicone use during gastroscopy and colonoscopy in improving mucosal assessment, adenoma detection rate, and reducing procedure time. There are no published reports of adverse events related specifically to the use of simethicone, delivered either orally or via any endoscope channel. An assessment of the risks and benefits supports the continued use of simethicone during endoscopic procedures. Strict adherence to instrument reprocessing protocols is essential.
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Affiliation(s)
- Benedict M Devereaux
- Medical School, University of Queensland, Brisbane, Queensland, Australia.,Gastroenterological Society of Australia, Melbourne, Victoria, Australia
| | - Andrew C F Taylor
- Gastroenterological Society of Australia, Melbourne, Victoria, Australia
| | - Eugene Athan
- Barwon Health, Deakin University, Geelong, Victoria, Australia.,Australasian Society of Infectious Diseases, Hobart, Tasmania, Australia
| | - David J Wallis
- Gastroenterological Society of Australia, Melbourne, Victoria, Australia
| | - Robyn R Brown
- Gastroenterological Nurses College of Australia, Beaumaris, Victoria, Australia
| | - Sue M Greig
- Australasian College for Infection Prevention and Control, Hobart, Tasmania, Australia
| | - Fiona K Bailey
- Gastroenterological Society of Australia, Melbourne, Victoria, Australia
| | - Karen Vickery
- Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth Wardle
- Gastroenterological Nurses College of Australia, Beaumaris, Victoria, Australia
| | - Dianne M Jones
- Gastroenterological Nurses College of Australia, Beaumaris, Victoria, Australia
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14
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Delgado Guillena PG, Morales Alvarado VJ, Jimeno Ramiro M, Rigau Cañardo J, Ramírez Salazar C, García Rodríguez A, Córdova Guevara H, Fernández Esparrach G. Gastric cancer missed at esophagogastroduodenoscopy in a well-defined Spanish population. Dig Liver Dis 2019; 51:1123-1129. [PMID: 30967337 DOI: 10.1016/j.dld.2019.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although esophagogastroduodenoscopy (EGD) is the standard procedure for the diagnosis of gastric cancer (GC), some GCs are missed. There are no published data on the missed rate of GC in Spain. AIMS To determine the frequency and characteristics of missed GCs and assess the quality of the EGD in a specific population with GC. METHODS Records of all patients diagnosed with gastric adenocarcinoma between 2012 and 2016 in a defined geographic area were reviewed. Missed GC was defined as a case with a prior negative EGD for cancer. Quality indicators from the prior EGDs were measured. RESULTS From 212 cases of GC, 25 cases were excluded. Seventeen out of 187 patients had a prior EGD (9.1%). Twelve of those 17 missed GC had a prior EGD with some abnormal findings. In 6 of them, biopsies were taken. Survival was no different between patients with missed and non-missed GC. Quality indicators that failed to meet standards were recording time, image documentation, and a protocol of biopsies. CONCLUSIONS Missed GC in an EGD in a defined population in Spain is not uncommon (9.1%). The endoscopist is an important factor in missed GC due to lack of adequate detection and sampling error. Compliance with performance of quality indicators could reduce missed GC.
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Affiliation(s)
- Pedro Genaro Delgado Guillena
- Department of Gastroenterology, Hospital General de Granollers, Barcelona, Spain; Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru.
| | | | | | | | | | | | - Henry Córdova Guevara
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gloria Fernández Esparrach
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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15
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Li Y, Du F, Fu D. The effect of using simethicone with or without N-acetylcysteine before gastroscopy: A meta-analysis and systemic review. Saudi J Gastroenterol 2019; 25:218-228. [PMID: 31044749 PMCID: PMC6714471 DOI: 10.4103/sjg.sjg_538_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/AIM To assess the efficacy and safety of simethicone with or without N-acetylcysteine (NAC) as premedications before gastroscopy. MATERIALS AND METHODS We searched EMBASE, PubMed, Cochrane library and Web of Science database for randomized clinical controlled trials regarding simethicone ± NAC as oral drinking agents before gastroscopy. Statistical software RevMan5.3 was used for statistical analysis. RESULTS Ten randomized clinical trials that fulfilled the inclusion criteria were further pooled into a meta-analysis, which included 5,750 patients. The rate of positive findings in simethicone plus NAC group was higher than that in water group (risk ratio [RR] =1.31, 95%CI: 1.12-1.53, P = 0.0006) with high level of evidence. There was no significant difference on the rate of positive findings when comparing simethicone with simethicone plus NAC (RR = 1.02, 95%CI: 0.90-1.16, P = 0.71) and with water (RR = 1.13, 95%CI: 0.82-1.55, P = 0.46), respectively. Simethicone plus NAC showed better total mucosal visibility score than simethicone alone (MD = -0.14 (-0.25, -0.03), P = 0.01) without obvious heterogeneity. Both simethicone plus NAC and simethicone alone offer more benefit than water. The procedure time in simethicone group was shorter than that in water group (MD = -1.23 (-1.51, -0.96), P < 0.00001). Regarding adverse events, there was no significant difference in simethicone and water group (RR = 0.45, 95%CI: 0.2-1.0, P = 0.05, I2 = 0%). CONCLUSIONS As premedication of gastroscopy, simethicone plus NAC offers more benefit on positive findings and total mucosal visibility score.
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Affiliation(s)
- Yuanfa Li
- Department of Gastroenterology, Xiantao First People's Hospital, China,Address for correspondence: Dr. Yuanfa Li, No. 29, Mianzhoudadao Road, Sha Zui District Xiantao City, Hubei Province, China. E-mail:
| | - Fangjuan Du
- Department of Gastroenterology, Liaocheng Second People's Hospital, China
| | - Dou Fu
- Internal Medicine, Xiantao First People's Hospital, China
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16
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Braden B, Jones-Morris E. How to get the most out of costly Barrett's oesophagus surveillance. Dig Liver Dis 2018; 50:871-877. [PMID: 29730158 DOI: 10.1016/j.dld.2018.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 12/11/2022]
Abstract
Current endoscopic surveillance protocols for Barrett's oesophagus have several limitations, mainly the poor cost-effectiveness and high miss rate. However, there is sufficient evidence that patients enrolled in a surveillance program have better survival chances of oesophageal cancer due to earlier tumor stages at diagnosis compared to patients with de novo diagnosed oesophagus cancer. Risk stratifications aim to identify patients at highest risk of developing adenocarcinoma of the oesophagus; most of them base on the length of the Barrett's segment and the presence of dysplasia. This review discusses prognostic factors and provides practical guidance on how to improve the efficacy and outcome in Barrett's surveillance programs.
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Affiliation(s)
- Barbara Braden
- Translation Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Evonne Jones-Morris
- Translation Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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17
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Ching HL, Healy A, Thurston V, Hale MF, Sidhu R, McAlindon ME. Upper gastrointestinal tract capsule endoscopy using a nurse-led protocol: First reported experience. World J Gastroenterol 2018; 24:2893-2901. [PMID: 30018484 PMCID: PMC6048428 DOI: 10.3748/wjg.v24.i26.2893] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/19/2018] [Accepted: 06/16/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To test the feasibility and performance of a novel upper gastrointestinal (GI) capsule endoscope using a nurse-led protocol.
METHODS We conducted a prospective cohort analysis of patients who declined gastroscopy (oesophagogastroduodenoscopy, OGD) but who consented to upper GI capsule endoscopy. Patients swallowed the upper GI capsule following ingestion of 1 liter of water (containing simethicone). A series of positional changes were used to exploit the effects of water flow and move the upper GI capsule from one gravity-dependent area to another using a nurse-led protocol. Capsule transit time, video reading time, mucosal visualisation, pathology detection and patient tolerance was evaluated.
RESULTS Fifty patients were included in the study. The mean capsule transit times in the oesophagus and stomach were 28 s and 68 min respectively. Visualisation of the following major anatomical landmarks was achieved (graded 1-5: Poor to excellent): Oesophagus, 4.8 (± 0.5); gastro-oesophageal junction (GOJ), 4.8 (± 0.8); cardia, 4.8 (± 0.8); fundus, 3.8 (± 1.2); body, 4.5 (± 1); antrum, 4.5 (± 1); pylorus, 4.7 (± 0.8); duodenal bulb, 4.7 (± 0.7); second part of the duodenum (D2), 4.7 (± 1). The upper GI capsule reached D2 in 64% of patients. The mean video reading time was 48 min with standard playback mode and 20 min using Quickview (P = 0.0001). No pathology was missed using Quickview. Procedural tolerance was excellent. No complications were seen with the upper GI capsule.
CONCLUSION The upper GI capsule achieved excellent views of the upper GI tract. Future studies should compare the diagnostic accuracy between upper GI capsule and OGD.
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Affiliation(s)
- Hey-Long Ching
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, United Kingdom
| | - Ailish Healy
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, United Kingdom
| | - Victoria Thurston
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, United Kingdom
| | - Melissa F Hale
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, United Kingdom
| | - Reena Sidhu
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, United Kingdom
| | - Mark E McAlindon
- Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, United Kingdom
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18
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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. [PMID: 29971260 DOI: 10.21037/tgh.2018.05.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/03/2018] [Indexed: 01/01/2023] Open
Abstract
Background The objective of this article is to study the role of Simethicone ± N-acetylcysteine in improving the mucosal visualization during oesophago-gastro-duodenoscopy (OGD). Methods The data retrieved from the published randomized controlled trials (RCTs) reporting the role of Simethicone ± N-acetylcysteine during OGD was analysed using the principles of meta-analysis. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR). Results Three RCTs on 654 patients reported OGD with and without pre-procedure oral administration of Simethicone ± N-acetylcysteine evaluating visibility as good or excellent in number during the procedure. In the random effects model analysis using the statistical software Review Manager 5.3, the use of Simethicone ± N-acetylcysteine was associated with improved (OR, 0.43; 95% CI, 0.28, 0.68; z=3.65; P=0.0003) mucosal visibility. Four RCTs on 364 patients reported OGD with and without pre-procedure oral administration of Simethicone ± N-acetylcysteine evaluating visibility score in study group. In the random effects model analysis using the statistical software Review Manager 5.3, the use of Simethicone ± N-acetylcysteine was associated with improved (SMD, -1.66; 95% CI, -1.93, -1.40; z=12.25; P=0.00001) mucosal visibility score compared to no-Simethicone group. Conclusions The findings of current study on 1,099 patients successfully demonstrate that the pre-procedure oral administration of Simethicone ± N-acetylcysteine improves mucosal visualization and mucosal visualization score during OGD.
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Affiliation(s)
- Muhammad Shafique Sajid
- Department of General and Colorectal Surgery, Brighton & Sussex University Hospitals NHS Trust, The Royal Sussex County Hospital, Brighton, UK
| | - Saad Rehman
- Department of General and Colorectal Surgery, Brighton & Sussex University Hospitals NHS Trust, The Royal Sussex County Hospital, Brighton, UK
| | - Fergus Chedgy
- Department of Gastroenterology & Hepatology, Brighton & Sussex University Hospitals NHS Trust, The Royal Sussex County Hospital, Brighton, UK
| | - Krishna K Singh
- Department of General and Upper GI Surgery, Brighton & Sussex University Hospitals NHS Trust, The Royal Sussex County Hospital, Brighton, UK
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19
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Benmassaoud A, Parent J. Canadian Association of Gastroenterology Position Statement on the Impact of Simethicone on Endoscope Reprocessing. J Can Assoc Gastroenterol 2018; 1:40-42. [PMID: 31294395 PMCID: PMC6487999 DOI: 10.1093/jcag/gwx002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A recent study by Ofstead et al. published in the American Journal of Infection Control described the presence of residual simethicone and non-pathogenic bacterial colonization in endoscopes despite adherence to reprocessing procedures(1). These findings received significant media attention, in part because they were released following a warning issued by the Food and Drug Administration and the Centre for Disease Control regarding the potential transmission of multi-drug resistant bacteria associated with the use of duodenoscopes(2, 3). In light of the findings described by Ofstead et al., the Canadian Association of Gastroenterology (CAG) would like to update its members on what is currently known.
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Affiliation(s)
- Amine Benmassaoud
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - Josée Parent
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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20
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Ching HL, Hale MF, Sidhu R, McAlindon ME. Reassessing the value of gastroscopy for the investigation of dyspepsia. Frontline Gastroenterol 2018; 9:62-66. [PMID: 29484162 PMCID: PMC5824766 DOI: 10.1136/flgastro-2017-100838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/29/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic yield of investigating dyspepsia with oesophagogastroduodenoscopy (OGD) with or without mucosal biopsy. DESIGN Retrospective service evaluation study. SETTING Two teaching hospitals: The Royal Hallamshire Hospital and Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK. PATIENTS 500 patients, 55 years of age and over, who underwent OGD to investigate dyspepsia were included. The study period included a 3-month window. All OGDs were performed on an outpatient basis. INTERVENTIONS Data were extracted from electronic OGD records within the study period. MAIN OUTCOME MEASURES Diagnostic yield provided by endoscopic examination and histological assessment. RESULTS 378 patients (75.6%) were reported to have some form of endoscopic abnormality, and 417 patients (83.4%) had biopsies taken. The most common findings at OGD were gastritis (47.2%) and oesophagitis (24.4%). Oesophagogastric malignancy was seen in 1%. Diagnoses made endoscopically or histologically that would not have been appropriately managed by empirical therapies were seen in 16.2%. CONCLUSION OGD in dyspepsia influences patient management in approximately one-sixth of cases. However, the majority of patients are sufficiently managed with Helicobacter pylori testing and eradication and/or a trial of proton pump inhibitor therapy. Further non-invasive approaches are needed to identify patients who need endoscopy for biopsy or therapy.
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Affiliation(s)
- Hey-Long Ching
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Melissa F Hale
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Reena Sidhu
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Mark E McAlindon
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
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