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N-acetylcysteine and simethicone improve mucosal visualization during gastroscopy

Premedication with N-acetylcysteine and simethicone improves mucosal visualization during gastroscopy, reports the latest issue of the European Journal of Gastroenterology & Hepatology.

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Diagnostic gastroscopy provides a unique opportunity to diagnose early oesophagogastric neoplasia.

However, intraluminal mucus and bile can obscure mucosal visualization.

Dr Neale James and colleagues determined whether the use of a premedication solution containing the mucolytic agent N-acetylcysteine, and the surfactant simethicone improves mucosal visualization within a UK diagnostic gastroscopy service.

The research team reported that a total of 75 consecutive patients were recruited from a single endoscopist’s diagnostic gastroscopy list.

They were randomized into 3 treatment groups.

Group 1 included standard control patients who received clear fluids only for 6 hours, and nil by mouth for 2 hours.

Group 2 included the water control group who received standard control plus 100 ml sterile water.

Group 3, the solution group, received standard control plus 100 ml investigated solution.

The doctors reported that the endoscopist was blinded to patient preparation.

Inadequate mucosal visualization was defined as fluid/mucus during gastroscopy that could not be suctioned, and required flushing with water.

The team of researchers recorded the volume of flush, the site at which it was used, and the total procedure times.

The mean overall procedure time was also less in the solution group
European Journal of Gastroenterology & Hepatology

All 3 groups showed no statistical difference for age, sex ratio, procedure priority or indication.

The mean volume of flush required to obtain clear mucosa was significantly less in the solution group compared with the other groups.

The doctors observed that the mean overall procedure time was also less in the solution group compared with the other groups.

Dr James's team concluded, "Premedication with N-acetylcysteine and simethicone markedly improves mucosal visibility during gastroscopy."

"It also reduces the time taken for the procedure."

"This low-cost and well-tolerated intervention may improve detection of early neoplasia."

Euro J of Gastroenterol & Hepatol 2013:25(7): 778-783
10 July 2013

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