Background and Study Aims: The study tested whether pronase can improve endoscopic visibility and alter the accuracy of the CLO test for H. pylori detection.
Patients and Methods: A total of 160 patients were randomly assigned to receive one of five premedications for endoscopy: group A: dimethylpolysiloxane (DMPS) alone; group B: DMPS plus water (up to 100 ml); group C: pronase only, with 100 ml water; group D: pronase and sodium bicarbonate plus water up to 100 ml; group E: pronase, sodium bicarbonate, and DMPS, plus water up to 100 ml. Endoscopists, who were unaware of the premedication method administered, assessed visibility scores (range 1 - 4) for the antrum, lower gastric body, upper gastric body, and fundus. The higher the score, the less clear the visibility. The sum of scores from the four locations was defined as the total visibility score. A CLO test was also done during the endoscopy. One week after their endoscopy, patients in groups C, D, and E were scheduled for a 13C-urea breath test (UBT).
Results: Group E patients had a significantly lower total visibility score than those in the other four groups (P < 0.05). Groups C and D had higher total visibility scores than the other three groups (P < 0.05). The scores did not significantly differ between groups A and B. Based on the UBT results, the sensitivity and specificity of the CLO test were 92.6 % and 96.2 %, respectively.
Conclusions: Premedication as in group E provided the clearest endoscopic visibility. Without the application of DMPS, pronase alone cannot improve endoscopic visibility. Pronase does not influence H. pylori identification using the CLO test.
References
-
1
Banerjee B, Paker J, Waits W. et al .
Effectiveness of preprocedure simethicone drink in improving visibility during esophagogastroduodenoscopy: a double-blind, randomized study.
J Clin Gastroenterol.
1992;
15
264-265
-
2
McDonald G B, O'Leary R, Stratton C.
Pre-endoscopic use of oral simethicone.
Gastrointest Endosc.
1978;
24
283
-
3
Waye J D, Pittman E, Weiss A. et al .
The bubble problem in endoscopy.
Gastrointest Endosc.
1967;
14
34-35
-
4
Tomoko F, Hiroyasu I, Masahauru T. et al .
Effectiveness of premedication with pronase for improving visibility during gastroendoscopy: a randomized controlled trial.
Gastrointest Endosc.
1998;
47
382-387
-
5
Sanuki M, Tada M, Shiraishi Y. et al .
Clinical study of KPD (pronase), as a premedication for endoscopy.
Clin Rep.
1991;
25
1500-1504
-
6
Koga M, Arakawa K.
On the application of enzymatic mucinolysis in x-ray diagnosis of the stomach.
Nippon Acta Radiol.
1964;
24
1011-1031
-
7
Lazzaroni M, Bianco-Porro G.
Premedication, preparation and surveillance.
Endoscopy.
1999;
31
2-8
-
8
Ida K, Okuda J, Kaneko E. et al .
Usefulness of premedication with KPD (pronase) in gastroendoscopy: placebo-controlled double-blind study in conventional endoscopy.
Clin Rep.
1991;
25
1781-1792
-
9
Gotoh A, Shimizu T, Kaneko T. et al .
The 3rd Annual Meeting of the Japanese Research Society for Helicobacter pylori.
.
Related Gastroduodenal Disease.
1997;
(proceeding)
37
-
10
Kimura K, Ido K, Saifuku K. et al .
A 1-h topical therapy for the treatment of Helicobacter pylori infection.
Am J Gastroenterol.
1995;
90
60-63
-
11
Sheu B S, Lee S C, Lin P W. et al .
Carbon urea breath test is not as accurate as endoscopy to detect Helicobacter pylori after gastrectomy.
Gastrointest Endosc.
2000;
51
670-675
-
12
Sheu B S, Lee S C, Yang H B. et al .
Quantitative result of 13C urea breath test at 15 minutes may correlate with the bacterial density of H. pylori in the stomach.
Hepatogastroenterology.
1999;
46
2057-2062
-
13
Ida K, Hashimoto Y, Takeda S. et al .
Endoscopic diagnosis of gastric cancer with dye scattering.
Am J Gastroenterol.
1975;
63
316-320
-
14
Wu D C, Lu C Y, Lu Y C. et al .
Endoscopic hydrogen peroxide spray may facilitate localization of the bleeding site in acute upper gastrointestinal bleeding.
Endoscopy.
1999;
31
237-241
-
15
Bertoni G, Gumina C, Conigliaro R. et al .
Randomized placebo-controlled trial of oral liquid simethicone prior to upper gastrointestinal endoscopy.
Endoscopy.
1992;
24
268-270
C.-H. Chuang, M.D.
Dept. of Internal Medicine · National Cheng Kung University Hospital
138, Sheng Li Road · Tainan · Taiwan
Fax: + 886-6-2766116
eMail: jasonc@mail.ncku.edu.tw
