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Nabi Z, Vamsi M, Goud R, Sayyed M, Basha J, Reddy PM, Reddy R, Reddy P, Manchu C, Darisetty S, Gupta R, Tandan M, Rao GV, Reddy DN. Pre-medication with simethicone and N-acetyl cysteine for improving mucosal visibility during upper gastrointestinal endoscopy: A randomized controlled trial. Indian J Gastroenterol 2023:10.1007/s12664-023-01459-0. [PMID: 37848768 DOI: 10.1007/s12664-023-01459-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/02/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND AIM Diagnostic performance of esophagogastroduodenoscopy (EGD) may be compromized due to adherent mucus and foam. In this study, we aimed at assessing the impact of premedication on mucosal visibility during endoscopy. METHODS This is a double-blinded (patient and investigator), 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 minutes before endoscopy and mucosal visibility graded from 1 (best) to 4 (worst) (1 best, 4 worst). Total mucosal visibility scores (TMVS) from six sites ranged from 6 (best) to 24 (worst) points. The primary outcome of study was comparison of TMVS between simethicone and combination (S + NAC) premedication groups. Secondary outcomes were adverse events and impact of endoscopy timing on TMVS. RESULTS Total 800 patients (39 years, 68.8% males) were randomized into four groups. Median TMVS were significantly lower in groups B (7 [6-8]) and D (8 [6-9]) as compared to A (11 [9-13]) and C (10 [8-12]). Proportion of cases with adequate gastric mucosal visibility (score < 7) was 26% in group A, 71% in group B, 36% in group C and 79% in group D. There was no difference in TMVS in groups A and C (p = 0.137). TMVS were significantly lower in late (> 20-30 minutes) vs. early (10-20 minutes) endoscopy sub-group (8 [7-11] vs, 9 ([7-11], p = 0.001). However, TMVS were similar between group B and group D in early endoscopy group (p = 0.451). There was no significant difference in the lesion detection rate among the different premedication drugs (p > 0.05). CONCLUSIONS Premedication with simethicone or combination (simethicone and NAC) significantly improves mucosal visibility during EGD. If early endoscopy is indicated, simethicone provides similar mucosal visibility and may be an effective alternative to combined premedication. TRIAL REGISTRATION NCT05951712.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India.
| | - Mohan Vamsi
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Rajesh Goud
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Mahiboob Sayyed
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Jahangeer Basha
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Palle Manohar Reddy
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Rithesh Reddy
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Praveen Reddy
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Chaithanya Manchu
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Santosh Darisetty
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Rajesh Gupta
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Manu Tandan
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - Guduru Venkat Rao
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
| | - D Nageshwar Reddy
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India
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Stepan M, Fojtík P, Psar R, Hanousek M, Sabol M, Zapletalova J, Falt P. Administration of maximum dose of mucolytic solution before upper endoscopy - a double-blind, randomized trial. Eur J Gastroenterol Hepatol 2023; 35:635-640. [PMID: 37115977 PMCID: PMC10144268 DOI: 10.1097/meg.0000000000002559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/11/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE The aim of the study was to demonstrate that an administration of mucolytic solution with a maximum dose of simethicone and n -acetylcysteine before upper endoscopy improves mucosal visibility compared to a group without administration of mucolytic solution or water. METHODS This study was a double-blind, randomized controlled trial. Patients were randomized into four groups, with the administration of 100 ml of water + 600 mg n -acetylcysteine + 400 mg simethicone, 100 ml of water + 400 mg n -acetylcysteine + 20 mg simethicone, 100 ml of water, and without any water or mucolytic solution. During the examination, a total of 10 images were taken in the defined areas. The overall visibility score was given by the sum of the 0-5 scores of the five areas and was assessed by the endoscopist performing the procedure and the blinded endoscopists using static images. RESULTS A total of 129 patients were randomized. The group of patients did not differ in age, sex distribution, and indications significantly. The overall visibility score as assessed by the endoscopist performing the procedure was significantly higher in the group with the maximum dose of mucolytic solution compared to the group without solution or water (18.9 ± 2.9 vs. 16.6 ± 3.3, P = 0.023). This difference was not evident by the blinded evaluation of static photographs. CONCLUSION Administration of mucolytic solution with a maximum dose of n -acetylcysteine and simethicone before upper endoscopy improved mucosal visibility in the upper gastrointestinal tract compared with the group without any preparation while evaluated by performing endoscopist.
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Affiliation(s)
- Michal Stepan
- Digestive Diseases Center, Vítkovice Hospital
- Faculty of Medicine, University of Ostrava, Ostrava
- Faculty of Medicine, Palacky University, Olomouc
| | - Petr Fojtík
- Digestive Diseases Center, Vítkovice Hospital
- Faculty of Medicine, University of Ostrava, Ostrava
| | - Robert Psar
- Department of Radiology, Vítkovice Hospital, Ostrava
- Department of Radiology, Faculty of Medicine and Dentistry, University Hospital Olomouc
| | | | - Marek Sabol
- Digestive Diseases Center, Vítkovice Hospital
| | | | - Premysl Falt
- 2nd Department of Internal Medicine, University Hospital and Faculty of Medicine, Palacky University, Olomouc, Czech Republic
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Kamran U, King D, Abbasi A, Coupland B, Umar N, Chapman WC, Hebbar S, Trudgill NJ. A root cause analysis system to establish the most plausible explanation for post-endoscopy upper gastrointestinal cancer. Endoscopy 2023; 55:109-118. [PMID: 36044914 DOI: 10.1055/a-1917-0192] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND : Missing upper gastrointestinal cancer (UGIC) at endoscopy may prevent curative treatment. We have developed a root cause analysis system for potentially missed UGICs at endoscopy (post-endoscopy UGIC [PEUGIC]) to establish the most plausible explanations. METHODS : The electronic records of patients with UGIC at two National Health Service providers were examined. PEUGICs were defined as UGICs diagnosed 6-36 months after an endoscopy that did not diagnose cancer. An algorithm based on the World Endoscopy Organization post-colonoscopy colorectal cancer algorithm was developed to categorize and identify potentially avoidable PEUGICs. RESULTS : Of 1327 UGICs studied, 89 (6.7 %) were PEUGICs (patient median [IQR] age at endoscopy 73.5 (63.5-81.0); 60.7 % men). Of the PEUGICs, 40 % were diagnosed in patients with Barrett's esophagus. PEUGICs were categorized as: A - lesion detected, adequate assessment and decision-making, but PEUGIC occurred (16.9 %); B - lesion detected, inadequate assessment or decision-making (34.8 %); C - possible missed lesion, endoscopy and decision-making adequate (8.9 %); D - possible missed lesion, endoscopy or decision-making inadequate (33.7 %); E - deviated from management pathway but appropriate (5.6 %); F - deviated inappropriately from management pathway (3.4 %). The majority of PEUGICs (71 %) were potentially avoidable and in 45 % the cancer outcome could have been different if it had been diagnosed on the initial endoscopy. There was a negative correlation between endoscopists' mean annual number of endoscopies and the technically attributable PEUGIC rate (correlation coefficient -0.57; P = 0.004). CONCLUSION : Missed opportunities to avoid PEUGIC were identified in 71 % of cases. Root cause analysis can standardize future investigation of PEUGIC and guide quality improvement efforts.
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Affiliation(s)
- Umair Kamran
- Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Dominic King
- Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Abdullah Abbasi
- Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ben Coupland
- Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nosheen Umar
- Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Warren C Chapman
- Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Srisha Hebbar
- Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, West Bromwich, UK
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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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Kim SY, Park JM. Quality indicators in esophagogastroduodenoscopy. Clin Endosc 2022; 55:319-331. [PMID: 35656624 PMCID: PMC9178133 DOI: 10.5946/ce.2022.094] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/22/2022] [Indexed: 11/25/2022] Open
Abstract
Esophagogastroduodenoscopy (EGD) has been used to diagnose a wide variety of upper gastrointestinal diseases. In particular, EGD is used to screen high-risk subjects of gastric cancer. Quality control of EGD is important because the diagnostic rate is examiner-dependent. However, there is still no representative quality indicator that can be uniformly applied in EGD. There has been growing awareness of the importance of quality control in improving EGD performance. Therefore, we aimed to review the available and emerging quality indicators for diagnostic EGD.
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Affiliation(s)
- Sang Yoon Kim
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jae Myung Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Photomedicine Research Institute, The Catholic University of Korea, Seoul, Korea
- Correspondence: Jae Myung Park Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea E-mail:
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Liu YW, Wang YC, Zhu JH, Jiang X, Zhou W, Zhang J, Liao Z, Linghu EQ. Magnetically controlled capsule endoscopy in one-time gastro-small intestinal joint examination: a two-centre experience. BMC Gastroenterol 2022; 22:222. [PMID: 35509022 PMCID: PMC9069740 DOI: 10.1186/s12876-022-02302-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/25/2022] [Indexed: 12/12/2022] Open
Abstract
Background The lesions of certain diseases are widely distributed in both stomach and small intestine, while the step-by-step strategy of gastroscopy followed by enteroscopy can be burdensome and costly. We aimed to determine if magnetically controlled capsule endoscopy (MCE) could be used in one-time gastro-small intestine (GSI) joint examination. Methods In this study, data of patients in Chinese PLA General Hospital and Changhai Hospital who underwent MCE GSI examination from January 2020 to August 2021 were retrospectively analysed. The primary outcome of this study was the success rate of one-time GSI joint examination, and secondary outcomes included visualization and cleanliness of gastrointestinal tract, gastrointestinal transit times, diagnostic yield and safety of MCE examination. Results A total of 768 patients were included. The success rate of one-time GSI joint examination was 92.58%. There were 94.92% MCEs observed > 90% gastric mucosa in the 6 anatomic landmarks. The rate of complete small bowel examination was 97.40%. The median gastric examination time, gastric transit time and small intestine transit time were 8.18 min, 63.89 min and 4.89 h, respectively. Magnetic steering of MCE significantly decreased gastric transit time (8.92 min vs. 79.68 min, P = 0.001) and increased duodenal lesion detection rate (13.47% vs. 6.26%, P = 0.001) when compared with non-magnetic steering group. Two capsules were retained and were removed by enteroscopy or spontaneously excreted. Conclusions MCE is feasible to complete GSI joint examination and the detection of both gastric and small intestinal diseases can be achieved simultaneously. Trial registration Clinical Trial Registration ClinicalTrials.gov, ID: NCT05069233. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02302-0.
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Affiliation(s)
- Ya-Wei Liu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital/Chinese PLA Postgraduate Military Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Yuan-Chen Wang
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Jia-Hui Zhu
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Xi Jiang
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Wei Zhou
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Jie Zhang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital/Chinese PLA Postgraduate Military Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Zhuan Liao
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.
| | - En-Qiang Linghu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital/Chinese PLA Postgraduate Military Medical School, 28 Fuxing Road, Beijing, 100853, China.
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Guo Q, Fan X, Zhu S, Zhao X, Fang N, Guo M, Liu Z, Han Y. Comparing N-acetylcysteine with sodium thiosulfate for relieving symptoms caused by Lugol's iodine chromoendoscopy: a randomized, double-blind trial. Gastrointest Endosc 2022; 95:249-257. [PMID: 34371004 DOI: 10.1016/j.gie.2021.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/30/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Lugol's iodine chromoendoscopy is an important method to detect esophageal squamous cell carcinoma. Sodium thiosulfate solution (STS) has been used to neutralize iodine after Lugol's chromoendoscopy; however, it is not available in many medical centers. The aim of the current study was to assess the efficacy of N-acetylcysteine solution (NAC) for relieving symptoms caused by Lugol's iodine chromoendoscopy. METHODS Patients were randomized to receive either STS or NAC after spraying Lugol's iodine solution on the esophagus. The neutralizing effects for residual iodine in the esophagus and gastric mucous pool were observed. The primary endpoint was the intensity of retrosternal pain and/or heartburn measured by a visual analog scale (VAS) score 30 minutes after chromoendoscopy. Secondary endpoints were the rate of patients with any adverse symptom, rate of moderate to severe retrosternal discomfort occurring, and heart rate variability between time points before and after chromoendoscopy. RESULTS The neutralization rates for residual iodine between the NAC and STS groups were not significantly different (P > .999). The difference of median VAS scores between the NAC and STS groups 30 minutes after chromoendoscopy was .0 (P = .719; 95% confidence interval, .0-.0), and the 95% confidence interval higher limit was .0, which was less than our prespecified margin of .5, concluding an noninferiority of NAC with regard to STS. There was no significant difference between the 2 groups regarding the rate of patients with any adverse symptom, rate of moderate to severe retrosternal discomfort, or heart rate variability at 5 minutes or 30 minutes after chromoendoscopy. CONCLUSION As a very easily accessible reagent in clinical circumstances, NAC can also alleviate mucosal irritation symptoms induced by Lugol's chromoendoscopy at similar efficacy as STS and can be routinely recommended. (Clinical trial registration number: NCT04764643.).
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Affiliation(s)
- Quan Guo
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Xiaotong Fan
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Shaohua Zhu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Xin Zhao
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Na Fang
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Meng Guo
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Zhiguo Liu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Ying Han
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
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Shah SC, Piazuelo MB, Kuipers EJ, Li D. AGA Clinical Practice Update on the Diagnosis and Management of Atrophic Gastritis: Expert Review. Gastroenterology 2021; 161:1325-1332.e7. [PMID: 34454714 PMCID: PMC8740554 DOI: 10.1053/j.gastro.2021.06.078] [Citation(s) in RCA: 158] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023]
Abstract
DESCRIPTION The purpose of this Clinical Practice Update Expert Review is to provide clinicians with guidance on the diagnosis and management of atrophic gastritis, a common preneoplastic condition of the stomach, with a primary focus on atrophic gastritis due to chronic Helicobacter pylori infection-the most common etiology-or due to autoimmunity. To date, clinical guidance for best practices related to the diagnosis and management of atrophic gastritis remains very limited in the United States, which leads to poor recognition of this preneoplastic condition and suboptimal risk stratification. In addition, there is heterogeneity in the definitions of atrophic gastritis, autoimmune gastritis, pernicious anemia, and gastric neoplasia in the literature, which has led to confusion in clinical practice and research. Accordingly, the primary objective of this Clinical Practice Update is to provide clinicians with a framework for the diagnosis and management of atrophic gastritis. By focusing on atrophic gastritis, this Clinical Practice Update is intended to complement the 2020 American Gastroenterological Association Institute guidelines on the management of gastric intestinal metaplasia. These recent guidelines did not specifically discuss the diagnosis and management of atrophic gastritis. Providers should recognize, however, that a diagnosis of intestinal metaplasia on gastric histopathology implies the diagnosis of atrophic gastritis because intestinal metaplasia occurs in underlying atrophic mucosa, although this is often not distinctly noted on histopathologic reports. Nevertheless, atrophic gastritis represents an important stage with distinct histopathologic alterations in the multistep cascade of gastric cancer pathogenesis. METHODS The Best Practice Advice statements presented herein were developed from a combination of available evidence from published literature and consensus-based expert opinion. No formal rating of the strength or quality of the evidence was carried out. These statements are meant to provide practical advice to clinicians practicing in the United States. Best Practice Advice Statements BEST PRACTICE ADVICE 1: Atrophic gastritis is defined as the loss of gastric glands, with or without metaplasia, in the setting of chronic inflammation mainly due to Helicobacter pylori infection or autoimmunity. Regardless of the etiology, the diagnosis of atrophic gastritis should be confirmed by histopathology. BEST PRACTICE ADVICE 2: Providers should be aware that the presence of intestinal metaplasia on gastric histology almost invariably implies the diagnosis of atrophic gastritis. There should be a coordinated effort between gastroenterologists and pathologists to improve the consistency of documenting the extent and severity of atrophic gastritis, particularly if marked atrophy is present. BEST PRACTICE ADVICE 3: Providers should recognize typical endoscopic features of atrophic gastritis, which include pale appearance of gastric mucosa, increased visibility of vasculature due to thinning of the gastric mucosa, and loss of gastric folds, and, if with concomitant intestinal metaplasia, light blue crests and white opaque fields. Because these mucosal changes are often subtle, techniques to optimize evaluation of the gastric mucosa should be performed. BEST PRACTICE ADVICE 4: When endoscopic features of atrophic gastritis are present, providers should assess the extent endoscopically. Providers should obtain biopsies from the suspected atrophic/metaplastic areas for histopathological confirmation and risk stratification; at a minimum, biopsies from the body and antrum/incisura should be obtained and placed in separately labeled jars. Targeted biopsies should additionally be obtained from any other mucosal abnormalities. BEST PRACTICE ADVICE 5: In patients with histology compatible with autoimmune gastritis, providers should consider checking antiparietal cell antibodies and anti-intrinsic factor antibodies to assist with the diagnosis. Providers should also evaluate for anemia due to vitamin B-12 and iron deficiencies. BEST PRACTICE ADVICE 6: All individuals with atrophic gastritis should be assessed for H pylori infection. If positive, treatment of H pylori should be administered and successful eradication should be confirmed using nonserological testing modalities. BEST PRACTICE ADVICE 7: The optimal endoscopic surveillance interval for patients with atrophic gastritis is not well-defined and should be decided based on individual risk assessment and shared decision making. A surveillance endoscopy every 3 years should be considered in individuals with advanced atrophic gastritis, defined based on anatomic extent and histologic grade. BEST PRACTICE ADVICE 8: The optimal surveillance interval for individuals with autoimmune gastritis is unclear. Interval endoscopic surveillance should be considered based on individualized assessment and shared decision making. BEST PRACTICE ADVICE 9: Providers should recognize pernicious anemia as a late-stage manifestation of autoimmune gastritis that is characterized by vitamin B-12 deficiency and macrocytic anemia. Patients with a new diagnosis of pernicious anemia who have not had a recent endoscopy should undergo endoscopy with topographical biopsies to confirm corpus-predominant atrophic gastritis for risk stratification and to rule out prevalent gastric neoplasia, including neuroendocrine tumors. BEST PRACTICE ADVICE 10: Individuals with autoimmune gastritis should be screened for type 1 gastric neuroendocrine tumors with upper endoscopy. Small neuroendocrine tumors should be removed endoscopically, followed by surveillance endoscopy every 1-2 years, depending on the burden of neuroendocrine tumors. BEST PRACTICE ADVICE 11: Providers should evaluate for iron and vitamin B-12 deficiencies in patients with atrophic gastritis irrespective of etiology, especially if corpus-predominant. Likewise, in patients with unexplained iron or vitamin B-12 deficiency, atrophic gastritis should be considered in the differential diagnosis and appropriate diagnostic evaluation pursued. BEST PRACTICE ADVICE 12: In patients with autoimmune gastritis, providers should recognize that concomitant autoimmune disorders, particularly autoimmune thyroid disease, are common. Screening for autoimmune thyroid disease should be performed.
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Affiliation(s)
- Shailja C. Shah
- Gastroenterology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California,Division of Gastroenterology, University of California, San Diego, La Jolla, California
| | - M. Blanca Piazuelo
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ernst J. Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dan Li
- Department of Gastroenterology, Kaiser Permanente Northern California, Santa Clara, California,Division of Research, Kaiser Permanente Northern California, Oakland, California
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10
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Anikhindi SA, Kumar A, Uedo N, Singla V, Anikhindi A, Sharma P, Bansal N, Ranjan P, Kumar M, Sachdeva M, Khare S, Arora A. Pre-Endoscopy Drink of Simethicone and N-Acetylcysteine Significantly Improves Visualization in Upper Gastrointestinal Endoscopy. JOURNAL OF DIGESTIVE ENDOSCOPY 2021. [DOI: 10.1055/s-0041-1726225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Introduction With the advancements in diagnostic and therapeutic upper gastrointestinal endoscopy (UGIE), clear mucosal visualization is essential to ensure optimal outcomes. Though routinely followed in Japan and Korea, pre-endoscopic preparation is seldom used in India. We evaluated the efficacy of a pre-endoscopic drink of N-acetylcysteine (NAC) and simethicone in improving mucosal visibility during UGIE.
Patients and Methods This study was a retrospective, investigator blind study with a case–control study design. Cases included patients who received a pre-endoscopy drink of NAC and simethicone in 100 mL water administered 10 to 30 minutes prior to UGIE. Controls only had mandatory fasting for 6 to 8 hours prior to UGIE. Propensity score matching was done to ensure comparability between the groups. Digital images were taken at six standard landmarks during UGIE and stored. A blinded investigator subsequently analyzed the images and rated the mucosal visibility on a 3-point scale. The difference in the mean mucosal visibility between the cases and controls was compared.
Results Mean mucosal visibility during UGIE was significantly better using NAC with simethicone as compared with no preparation at esophagus (1.14 [0.37] vs. 1.47 [0.62], p < 0.05), gastric fundus (1.10 [0.30] vs. 1.55 [0.64], p < 0.05), gastric body (1.22 [0.50] vs. 1.62 [0.73], p < 0.05), gastric antrum (1.13 [0.37] vs. 1.47 [0.62], p < 0.05), and duodenal bulb (1.13 [0.34] vs. 1.33 [0.56], p < 0.05). In distal duodenum, though visibility improved with NAC with simethicone, the difference was insignificant. There were no adverse events related to the pre-endoscopy drink.
Conclusion A pre-endoscopy drink of NAC with simethicone can significantly improve mucosal visibility during UGIE. It is safe, cheap, easily available and maybe considered for routine utilization for ensuring optimal endoscopic outcomes.
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Affiliation(s)
- Shrihari Anil Anikhindi
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Kumar
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Vikas Singla
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Praveen Sharma
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Naresh Bansal
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Piyush Ranjan
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Mandhir Kumar
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Munish Sachdeva
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Shivam Khare
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Arora
- Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
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11
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Premedication with reformulated simethicone and sodium bicarbonate improves mucosal visibility during upper gastrointestinal endoscopy: a double-blind, multicenter, randomized controlled trial. BMC Gastroenterol 2021; 21:124. [PMID: 33736601 PMCID: PMC7977252 DOI: 10.1186/s12876-021-01623-w] [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: 09/12/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background The reformulated simethicone emulsion from Berlin Chemical AG might develop white flocculate precipitate covering the gastric mucosa when used before esophagogastroduodenoscopy (EGD). We aim to investigate whether combining the reformulated simethicone emulsion with 5% sodium bicarbonate solution could prevent the development of white precipitate and improve visibility during EGD. Methods Our clinical study involved 523 patients. They were randomly assigned to two groups. In Group A, patients received a warm solution containing 30 ml 5% sodium bicarbonate solution and 15 ml reformulated simethicone emulsion. In Group B, patients received 45 ml 40 °C lukewarm water. Visibility scores were recorded and analyzed. Flushes, volume of flush water, overall time taken for EGD and complications during or after the procedure were also recorded. Results We found that no white precipitate was observed during EGD in Group A. Moreover, visibility scores in Group A were significantly lower (P < 0.01). Patients in Group A had fewer flushes (P < 0.01) and smaller volume of flush water (P < 0.01). In addition, the overall time taken for the EGD procedure was significantly shorter in Group A (P < 0.01). The percentage of patients who had no adverse response was significantly higher in Group A than in Group B (P < 0.01). Conclusions Premedication with a mixed solution of 15 ml reformulated simethicone emulsion and 30 ml 5% sodium bicarbonate solution can prevent the development of white precipitate, substantially enhancing mucosal visibility safely. Trial registration: The registered name of the trial is “Efficacy of using premedication with reformulated simethicone emulsion during upper gastrointestinal endoscopy examination”. Its Current Controlled Trials number is ChiCTR1900021689. Its date of registration is 11 September 2019. Retrospectively registered, http://www.medresman.org.cn/uc/sindex.aspx. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01623-w.
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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: 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: 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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Chiu PWY, Uedo N, Singh R, Gotoda T, Ng EKW, Yao K, Ang TL, Ho SH, Kikuchi D, Yao F, Pittayanon R, Goda K, Lau JYW, Tajiri H, Inoue H. An Asian consensus on standards of diagnostic upper endoscopy for neoplasia. Gut 2019; 68:186-197. [PMID: 30420400 DOI: 10.1136/gutjnl-2018-317111] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/25/2018] [Accepted: 10/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND This is a consensus developed by a group of expert endoscopists aiming to standardise the preparation, process and endoscopic procedural steps for diagnosis of early upper gastrointestinal (GI) cancers. METHOD The Delphi method was used to develop consensus statements through identification of clinical questions on diagnostic endoscopy. Three consensus meetings were conducted to consolidate the statements and voting. We conducted a systematic literature search on evidence for each statement. The statements were presented in the second consensus meeting and revised according to comments. The final voting was conducted at the third consensus meeting on the level of evidence and agreement. RESULTS Risk stratification should be conducted before endoscopy and high risk endoscopic findings should raise an index of suspicion. The presence of premalignant mucosal changes should be documented and use of sedation is recommended to enhance detection of superficial upper GI neoplasms. The use of antispasmodics and mucolytics enhanced visualisation of the upper GI tract, and systematic endoscopic mapping should be conducted to improve detection. Sufficient examination time and structured training on diagnosis improves detection. Image enhanced endoscopy in addition to white light imaging improves detection of superficial upper GI cancer. Magnifying endoscopy with narrow-band imaging is recommended for characterisation of upper GI superficial neoplasms. Endoscopic characterisation can avoid unnecessary biopsy. CONCLUSION This consensus provides guidance for the performance of endoscopic diagnosis and characterisation for early gastric and oesophageal neoplasia based on the evidence. This will enhance the quality of endoscopic diagnosis and improve detection of early upper GI cancers.
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Affiliation(s)
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin and Modbury Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Takuji Gotoda
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | | | - Kenshi Yao
- Department of Endoscopy, University Chikushi Hospital, Fukuoka, Japan
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Shiaw Hooi Ho
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Fang Yao
- Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Rapat Pittayanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red Cross, Bangkok, Thailand
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - James Y W Lau
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy Research, Jikei University School of Medicine, Tokyo, Japan
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan
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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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Liao Z, Zou W, Li ZS. Clinical application of magnetically controlled capsule gastroscopy in gastric disease diagnosis: recent advances. SCIENCE CHINA-LIFE SCIENCES 2018; 61:1304-1309. [PMID: 30367341 DOI: 10.1007/s11427-018-9353-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/23/2018] [Indexed: 12/16/2022]
Abstract
Magnetically controlled capsule gastroscopy (MCCG) is a novel system primarily used for the diagnosis of gastric disease. It consists of an endoscopic capsule with magnetic material inside, external guidance magnet equipment, data recorder and computer workstation. Several clinical trials have demonstrated that MCCG is comparable in accuracy in diagnosing gastric focal disease when compared to conventional gastroscopy. Further clinical studies are needed to test the diagnostic accuracy and improve the functioning of MCCG. This novel MCCG system could be a promising alternative for screening for gastric diseases, with the advantages of no anesthesia required, comfort and high acceptance across populations.
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Affiliation(s)
- Zhuan Liao
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, 200433, China
| | - Wenbin Zou
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, 200433, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, 200433, China.
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17
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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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18
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Monrroy H, Vargas JI, Glasinovic E, Candia R, Azúa E, Gálvez C, Rojas C, Cabrera N, Vidaurre J, Álvarez N, González J, Espino A, González R, Parra-Blanco A. Use of N-acetylcysteine plus simethicone to improve mucosal visibility during upper GI endoscopy: a double-blind, randomized controlled trial. Gastrointest Endosc 2018; 87:986-993. [PMID: 29037773 DOI: 10.1016/j.gie.2017.10.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/01/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Upper GI endoscopy (UGE) is essential for the diagnosis of gastrointestinal diseases. Mucus and bubbles may decrease mucosal visibility. The use of mucolytics could improve visualization. Our aim was to determine whether premedication with simethicone or simethicone plus N-acetylcysteine is effective in improving visibility during UGE. METHODS This was a randomized, double-blinded, placebo-controlled trial with 2 control groups: no intervention and water 100 mL (W); and 3 intervention groups: simethicone 200 mg (S); S + N-acetylcysteine (NAC) 500 mg (S+NAC500); and S + NAC 1000 mg (S+NAC1000). The solution was ingested 20 minutes before UGE. Gastric visibility was evaluated in 4 segments with a previously described scale. A score of less than 7 points was defined as adequate visibility (AV). Water volume was used to improve visibility, and adverse reactions were evaluated as a secondary outcome. Multiple group comparison was performed using non-parametric one-way analysis of variance (ANOVA). RESULTS Two hundred thirty patients were included in the study, 68% female, mean age 49 years. The most common indication for UGE was epigastric pain/dyspepsia (33%). AV was more frequent in the S+NAC500 and S+NAC1000 groups (65% and 67%) compared with no intervention (44%, P = .044) and water (41%, P = .022). The gastric total visibility scale (TVS) was significantly better in the S+NAC500 and S+NAC1000 groups compared with water (P = .03 and P = .008). Simethicone was not different from no intervention and water. S+NAC1000 required less water volume to improve visibility. No adverse reactions from the study drugs were observed. CONCLUSIONS Premedication with S+NAC500 and S+NAC1000 improves visibility during UGE. The use of simethicone did not show improvements in gastric visibility. TVS was worse in patients using water alone. (Clinical trial registration number: NCT 01653171.).
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Affiliation(s)
- Hugo Monrroy
- Gastroenterology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | - Jose Ignacio Vargas
- Gastroenterology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | | | - Roberto Candia
- Gastroenterology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | - Emilio Azúa
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Gálvez
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Rojas
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Natalia Cabrera
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Josefa Vidaurre
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Natalia Álvarez
- Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | - Jessica González
- Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | - Alberto Espino
- Gastroenterology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | - Robinson González
- Gastroenterology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile
| | - Adolfo Parra-Blanco
- Gastroenterology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; Endoscopy Unit, Hospital Clínico Universidad Católica de Chile, Santiago, Chile; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, United Kingdom
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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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Gastric preparation for magnetically controlled capsule endoscopy: A prospective, randomized single-blinded controlled trial. Dig Liver Dis 2018; 50:42-47. [PMID: 29110963 DOI: 10.1016/j.dld.2017.09.129] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Magnetically controlled capsule endoscopy (MCE) is a novel technique for which there is no agreed gastric preparation. We aimed to determine an optimal standardized gastric preparation regimen. METHODS 120 patients referred for MCE were randomly assigned to gastric preparation with either water alone (A), water with simethicone (B) or water, simethicone and pronase (C). Image quality was assessed using cleanliness and visualization scores, higher scores equating to better image quality. RESULTS The total cleanliness scores were (mean±SD) 15.83±2.41 (A), 21.35±1.23 (B), and 20.82±1.90 (C). The total visualization scores (mean±SD) were 10.75±2.02 (A), 15.20±1.32 (B), and 15.08±1.86 (C). While the image quality of the whole stomach in groups B and C were significantly better than group A (P<0.0001), there was no statistical difference between group B and C (P>0.05). MCE detected positive findings in 21 (52.5%), 27 (67.5%) and 21 (53.8%) patients in group A, B and C respectively, with no significant difference between groups (P>0.5). CONCLUSIONS Simethicone swallowed with water prior to MCE produced the optimal gastric mucosal image quality. The addition of pronase had no demonstrable additional benefit.
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Beg S, Ragunath K, Wyman A, Banks M, Trudgill N, Pritchard DM, Riley S, Anderson J, Griffiths H, Bhandari P, Kaye P, Veitch A. Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut 2017; 66:1886-1899. [PMID: 28821598 PMCID: PMC5739858 DOI: 10.1136/gutjnl-2017-314109] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/26/2017] [Accepted: 07/12/2017] [Indexed: 12/18/2022]
Abstract
This document represents the first position statement produced by the British Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, setting out the minimum expected standards in diagnostic upper gastrointestinal endoscopy. The need for this statement has arisen from the recognition that while technical competence can be rapidly acquired, in practice the performance of a high-quality examination is variable, with an unacceptably high rate of failure to diagnose cancer at endoscopy. The importance of detecting early neoplasia has taken on greater significance in this era of minimally invasive, organ-preserving endoscopic therapy. In this position statement we describe 38 recommendations to improve diagnostic endoscopy quality. Our goal is to emphasise practices that encourage mucosal inspection and lesion recognition, with the aim of optimising the early diagnosis of upper gastrointestinal disease and improving patient outcomes.
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Affiliation(s)
- Sabina Beg
- Department of Gastroenterology, NIHR Nottingham Digestive Diseases Biomedical Research Centre, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Krish Ragunath
- Department of Gastroenterology, NIHR Nottingham Digestive Diseases Biomedical Research Centre, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Wyman
- Department of Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Matthew Banks
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Nigel Trudgill
- Department of Gastroenterology, Sandwell General Hospital, West Bromwich, UK
| | - D Mark Pritchard
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Stuart Riley
- Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
| | - John Anderson
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Helen Griffiths
- Department of Gastroenterology, Wye Valley NHS Trust, Herefordshire, UK
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Phillip Kaye
- Department of Histopathology, Nottingham University Hospitals NHS trust, Nottingham, UK
| | - Andrew Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
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Song M, Kwek ABE, Law NM, Ong JPL, Tan JYL, Harichander Thurairajah P, Ang DSW, Ang TL. Efficacy of small-volume simethicone given at least 30 min before gastroscopy. World J Gastrointest Pharmacol Ther 2016; 7:572-578. [PMID: 27867691 PMCID: PMC5095577 DOI: 10.4292/wjgpt.v7.i4.572] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/16/2016] [Accepted: 10/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the efficacy of 5 mL simethicone solution in decreasing gastric foam if given at least 30 min before gastroscopy.
METHODS This was a randomized, placebo controlled, endoscopist blinded study performed at Changi General Hospital. Patients were at least 21 years old, had no prior surgical resection of the upper gastrointestinal tract, and scheduled for elective diagnostic gastroscopies. The primary outcome was the total mucosal visibility score (TMVS) which was evaluated using McNally score. The sample size was calculated to be 24 per group (SD 2.4, 80% power, P < 0.05, 2-sample t test).
RESULTS Fifty-four patients were randomised to receive either simethicone [1 mL liquid simethicone (100 mg) in 5 mL of water] or placebo (5 mL of water) at least 30 min before their gastroscopy. Six accredited consultants conducted the gastroscopy, and the interobserver agreement of scoring TMVS was good with a Kappa statistic of 0.73. The simethicone group had significantly better mean TMVS compared to placebo (5.78 ± SD 1.65 vs 8.89 ± SD 1.97, P < 0.001). The improvement was statistically significant for the duodenum and the gastric antrum, angularis, body, and fundus. Percent 51.9 of patients in the simethicone group had a TMVS of 4 (no bubbles at all) to 5 (only 1 area with minimal bubbles), while in the placebo group 3.7% of patients had TMVS of 4 or 5. The number needed to treat was 2.1 to avoid a TMVS of 6 and more. The simethicone group also had a significantly shorter procedure time with less volume of additional flushes required during gastroscopy to clear away obscuring gastric foam.
CONCLUSION With a premedication time of at least 30 min, 5 mL simethicone can significantly decrease gastric foam, decrease the volume of additional flushes, and shorten gastroscopy time.
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Basford PJ, Brown J, Gadeke L, Fogg C, Haysom-Newport B, Ogollah R, Bhattacharyya R, Longcroft-Wheaton G, Thursby-Pelham F, Neale JR, Bhandari P. A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy - NICEVIS. Endosc Int Open 2016; 4:E1197-E1202. [PMID: 27853746 PMCID: PMC5110361 DOI: 10.1055/s-0042-117631] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/29/2016] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Peter John Basford
- Portsmouth Hospitals NHS trust – Endoscopy Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland,University of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland,Corresponding author Peter John Basford Queen Alexandra Hosp – GastroenterologySouthwick Hill Rd Cosham Portsmouth PO63LYUnited Kingdom of Great Britain and Northern Ireland+0789099044502392286255
| | - James Brown
- University of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland
| | - Lisa Gadeke
- Portsmouth Hospitals NHS trust – Endoscopy Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland
| | - Carole Fogg
- University of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland
| | - Ben Haysom-Newport
- University of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland
| | - Reuben Ogollah
- University of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland
| | - Rupam Bhattacharyya
- Portsmouth Hospitals NHS Trust – Gastroenterology, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland
| | - Gaius Longcroft-Wheaton
- Portsmouth Hospitals NHS trust – Endoscopy Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland,University of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland
| | - Fergus Thursby-Pelham
- Portsmouth Hospitals NHS trust – Endoscopy Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland
| | - James R. Neale
- South Devon Healthcare NHS Foundation Trust – Gastroenterology, Torquay, Torbay, United Kingdom of Great Britain and Northern Ireland
| | - Pradeep Bhandari
- Portsmouth Hospital – Endoscopy, Portsmouth, West Sussex, United Kingdom of Great Britain and Northern Ireland
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Simethicone residue remains inside gastrointestinal endoscopes despite reprocessing. Am J Infect Control 2016; 44:1237-1240. [PMID: 27497824 DOI: 10.1016/j.ajic.2016.05.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/06/2016] [Accepted: 05/07/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND During a study designed to assess endoscope reprocessing effectiveness, a borescope was used to examine lumens and ports. Cloudy, white, viscous fluid was observed inside fully reprocessed gastroscopes and colonoscopes. This fluid resembled simethicone, which is commonly administered to reduce foam and bubbles that impede visualization during gastrointestinal endoscopy. This article describes methods used to determine whether the observed fluid contained simethicone. METHODS Photographs of residual fluid were taken using a borescope. Sterile cotton-tipped swabs were used to collect samples of fluid observed in 3 endoscope ports. Samples were evaluated using Fourier transform infrared spectroscopy (FTIR)-attenuated total reflection analysis. RESULTS Residual fluid was observed inside 19 of 20 endoscopes. Fluid photographed in 8 endoscopes resembled simethicone solutions. FTIR analysis confirmed the presence of simethicone in 2 endoscopes. CONCLUSIONS Fluid containing simethicone remained inside endoscopes despite reprocessing. Simethicone is an inert, hydrophobic substance that may reduce reprocessing effectiveness. Simethicone solutions commonly contain sugars and thickeners, which may contribute to microbial growth and biofilm development. Studies are needed to assess the prevalence of residual moisture and simethicone in endoscopes and determine the impact on reprocessing effectiveness. We recommend minimizing the use of simethicone pending further research into its safety.
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Liao Z, Hou X, Lin-Hu EQ, Sheng JQ, Ge ZZ, Jiang B, Hou XH, Liu JY, Li Z, Huang QY, Zhao XJ, Li N, Gao YJ, Zhang Y, Zhou JQ, Wang XY, Liu J, Xie XP, Yang CM, Liu HL, Sun XT, Zou WB, Li ZS. Accuracy of Magnetically Controlled Capsule Endoscopy, Compared With Conventional Gastroscopy, in Detection of Gastric Diseases. Clin Gastroenterol Hepatol 2016; 14:1266-1273.e1. [PMID: 27211503 DOI: 10.1016/j.cgh.2016.05.013] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Diseases of the stomach, including gastric cancer and peptic ulcer, are the most common digestive diseases. It is impossible to visualize the entire stomach with the passive capsule currently used in practice because of the large size of the gastric cavity. A magnetically controlled capsule endoscopy (MCE) system has been designed to explore the stomach. We performed a prospective study to compare the accuracy of detection of gastric focal lesions by MCE vs conventional gastroscopy (the standard method). METHODS We performed a multicenter blinded study comparing MCE with conventional gastroscopy in 350 patients (mean age, 46.6 y), with upper abdominal complaints scheduled to undergo gastroscopy at a tertiary center in China from August 2014 through December 2014. All patients underwent MCE, followed by conventional gastroscopy 2 hours later, without sedation. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of detection of gastric focal lesions by MCE, using gastroscopy as the standard. RESULTS MCE detected gastric focal lesions in the whole stomach with 90.4% sensitivity (95% confidence interval [CI], 84.7%-96.1%), 94.7% specificity (95% CI, 91.9%-97.5%), a positive predictive value of 87.9% (95% CI, 81.7%-94.0%), a negative predictive value of 95.9% (95% CI, 93.4%-98.4%), and 93.4% accuracy (95% CI, 90.83%-96.02%). MCE detected focal lesions in the upper stomach (cardia, fundus, and body) with 90.2% sensitivity (95% CI, 82.0%-98.4%) and 96.7% specificity (95% CI, 94.4%-98.9%). MCE detected focal lesions in the lower stomach (angulus, antrum, and pylorus) with 90.6% sensitivity (95% CI, 82.7%-98.4%) and 97.9% specificity (95% CI, 96.1%-99.7%). MCE detected 1 advanced gastric carcinoma, 2 malignant lymphomas, and 1 early stage gastric tumor. MCE did not miss any lesions of significance (including tumors or large ulcers). Among the 350 patients, 5 reported 9 adverse events (1.4%) and 335 preferred MCE over gastroscopy (95.7%). CONCLUSIONS MCE detects focal lesions in the upper and lower stomach with comparable accuracy with conventional gastroscopy. MCE is preferred by almost all patients, compared with gastroscopy, and can be used to screen gastric diseases without sedation. Clinicaltrials.gov number: NCT02219529.
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Affiliation(s)
- Zhuan Liao
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xi Hou
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - En-Qiang Lin-Hu
- Department of Gastroenterology, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Jian-Qiu Sheng
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Zhi-Zheng Ge
- Division of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bo Jiang
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiao-Hua Hou
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ji-Yong Liu
- Department of Gastroenterology, Shandong Provincial Hospital, Jinan, China
| | - Zhen Li
- Department of Gastroenterology, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Qi-Yang Huang
- Department of Gastroenterology, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Xiao-Jun Zhao
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Na Li
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Yun-Jie Gao
- Division of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yao Zhang
- Division of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jie-Qiong Zhou
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin-Ying Wang
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun Liu
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Ping Xie
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cong-Mei Yang
- Department of Gastroenterology, Shandong Provincial Hospital, Jinan, China
| | - Hua-Lin Liu
- Department of Gastroenterology, Shandong Provincial Hospital, Jinan, China
| | - Xiao-Tian Sun
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wen-Bin Zou
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
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Callaghan JL, Neale JR, Boger PC, Sampson AP, Patel P. Variation in preparation for gastroscopy: lessons towards safer and better outcomes. Frontline Gastroenterol 2016; 7:187-190. [PMID: 28839856 PMCID: PMC5369482 DOI: 10.1136/flgastro-2015-100647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/20/2016] [Accepted: 02/07/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To identify the methods employed within the UK practice prior to diagnostic gastroscopy and compare with published guidelines for patients undergoing general anaesthesia. DESIGN National Health Service (NHS) endoscopy units were invited to take part in a structured telephone survey to determine the length of time patients are kept nil-by-mouth (NBM) for food and fluids prior to gastroscopy, and whether a preprocedure mucolytic drink was used. METHODS 212 NHS Trusts providing endoscopy services were identified from the Joint Advisory Group on GI Endoscopy. Trusts were excluded if they were children's hospitals (n=5). RESULTS 207 NHS Trusts were telephoned. 193 completed the survey (93%), 11 Trusts declined and there was no response from 3 Trusts. 13 separate policies regarding NBM timings were identified. 51 Trusts (21%) used the timings ratified by Surgical and Anaesthetic Societies (6 h NBM for food, 2 h for clear fluid). 135 Trusts (70%) used a policy which starved patients in excess of the standard surgical guidelines. No Trust used a mucolytic drink prior to gastroscopy. CONCLUSIONS The survey revealed large variation in NHS Trust's policies regarding the times patients were starved prior to gastroscopy. Results of surgical studies demonstrate increased risk of significant pulmonary aspiration with increased fluid-starvation periods, 68% of NHS endoscopy policy would be deemed excessive by surgical practice. There is no routine use of a mucolytic drink to improve mucosal visualisation in the UK practice.
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Affiliation(s)
- J L Callaghan
- Department of Luminal Gastroenterology, University Hospital Southampton, Southampton, UK
| | - J R Neale
- Department of Gastroenterology, Torbay Hospital, Torquay, UK
| | - P C Boger
- Department of Luminal Gastroenterology, University Hospital Southampton, Southampton, UK
| | - A P Sampson
- Department of Clinical and Experiment Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - P Patel
- Department of Luminal Gastroenterology, University Hospital Southampton, Southampton, UK
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Ching HL, Hale MF, McAlindon ME. Current and future role of magnetically assisted gastric capsule endoscopy in the upper gastrointestinal tract. Therap Adv Gastroenterol 2016; 9:313-21. [PMID: 27134661 PMCID: PMC4830104 DOI: 10.1177/1756283x16633052] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Capsule endoscopy first captivated the medical world when it provided a means to visualize the small bowel, which was previously out of endoscopic reach. In the subsequent decade and a half we continue to learn of the true potential that capsule endoscopy has to offer. Of particular current interest is whether capsule endoscopy has any reliable investigative role in the upper gastrointestinal tract. Much research has already been dedicated to enhancing the diagnostic and indeed therapeutic properties of capsule endoscopy. Specific modifications to tackle the challenges of the gut have already been described in the current literature. In the upper gastrointestinal tract, the capacious anatomy of the stomach represents one of many challenges that capsule endoscopy must overcome. One solution to improving diagnostic yield is to utilize external magnetic steering of a magnetically receptive capsule endoscope. Notionally this would provide a navigation system to direct the capsule to different areas of the stomach and allow complete gastric mucosal examination. To date, several studies have presented promising data to support the feasibility of this endeavour. However the jury is still out as to whether this system will surpass conventional gastroscopy, which remains the gold standard diagnostic tool in the foregut. Nevertheless, a minimally invasive and patient-friendly alternative to gastroscopy remains irresistibly appealing, warranting further studies to test the potential of magnetically assisted capsule endoscopy. In this article the authors would like to share the current state of magnetically assisted capsule endoscopy and anticipate what is yet to come.
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Affiliation(s)
| | - Melissa Fay Hale
- Clinical Investigations Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
| | - Mark Edward McAlindon
- Clinical Investigations Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
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28
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Magnetic-assisted capsule endoscopy in the upper GI tract by using a novel navigation system (with video). Gastrointest Endosc 2016; 83:889-895.e1. [PMID: 26405045 DOI: 10.1016/j.gie.2015.09.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 09/14/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Capsule endoscopy for visualization of the upper GI tract has thus far been experimental and potentially expensive. Our aim was to demonstrate the maneuverability and evaluate the ability to completely visualize and maintain views in the upper GI tract by using a simple magnetic-assisted capsule endoscopy (MACE) system. METHODS Twenty-six volunteers were recruited. The hand-held magnet was placed at strategic points on the body surface and rotated to hold and maneuver the capsule. The ability to view the upper GI tract landmarks was noted: esophagogastric junction (EGJ), cardia, fundus, body, incisura, antrum, and pylorus. Control was assessed by the ability to hold the capsule for 1 minute at 5 positions: the lower esophagus and 4 designated positions in the proximal and distal stomach and also traversing the stomach and through the pylorus. Volunteers subsequently underwent a standard gastroscopy. RESULTS The median data are as follows: age, 38 years (range 26-45 years); BMI, 24 (range 19-38); and procedure time, 24 minutes (range 12-39 minutes). Successful visualization of each landmark was EGJ, 92%; cardia, 88%; fundus, 96%; body, 100%; incisura, 96%; antrum, 96%; and pylorus, 100%; with fewer clear views of the EGJ and fundus. The capsule could be held in 88% of designated positions for 1 minute, moved from the fundus to the antrum in all cases, and traversed the pylorus in 50% (n = 13). An age of 40 years and older was associated with successful pyloric traversing (P = .04). There was positive concordance for 8 of 9 minor pathological findings on standard gastroscopy. CONCLUSION MACE in the upper GI tract is feasible. There is a high degree of visualization and control, with some improvement required for optimizing proximal gastric views and traversing the pylorus.
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