EFFECTIVENESS OF PREMEDICATION WITH SYMETICHONE AND N-ACETYLCYSTEINE TO IMPROVE VISIBILITY DURING UPPER GI ENDOSCOPY: A RANDOMIZED CONTROLLED TRIAL

Aims During esophagogastroduodenoscopy (EGDS) bubbles, bile and mucus often compromise the endoscopic visualization. Consensus about the importance of tensioactive and mucolytic drugs such as symetichone (SIM) and N-acetylcysteine (NAC) is lacking in Western world.

Present randomized controlled study aims to evaluate the effectiveness of premedication with SIM and NAC to improve endoscopic visibility.

Methods In 2019, 200 consecutive outpatients (105 M; 95 F) were enrolled. Sample size for each group was calculated as 70 patients per arm. Randomization list was 1:1.

200 patients were consecutively recruited and randomized to Group A (NAC 600 mg+SIM 2ml in 45 ml of H₂O p.o.) and Group B (no preparation). Preparation was administered 20 minutes before EGDS. 4 expert endoscopists blinded to the premedication, assigned a score from 0 to 3 for each part of the stomach (Fundus,F;Body,B;Antrum,A) and distal esophagus(E), with higher score corresponding to a clearer view. Mouth to Clean time (MtCt), Mouth to Mouth time (MtMt) and amount of water used to clean were recorded. Statistical analysis used non parametric tests.

Results 100 patients were enrolled for each arm, with not significant difference for demographics (A 54 M, 46 F;B 48 M, 52 F). Group A showed total mean (7.6 ± 1.5 vs. 6 ± 0.7, P< 0.001) and partial mean scores higher in all parts of the stomach than Group B. Water used to clean was significantly less in patients A than in B (44 ml vs 128 ml, P< 0.001).

There was a significant difference in MtCt (2.3 ± 1.6 min in group A vs 3.8 ± 1.6 min, P< 0.001 in group B) whereas no significant difference there was in MtMt (9.4 ± 3.8 min vs 9.8 ± 2.1 min, P=0.178).

Conclusions Present RCT supports recommendation of premedication with SIM and NAC before EGDS for a better endoscopic visualization of gastric mucosa.