Effect of Premedication With Pronase Before Upper Gastrointestinal Endoscopy: A Multicenter Prospective Randomized...

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Diagnostic Imaging

Background:

• Endoscopic visualization is crucial for detecting gastrointestinal lesions.
• Improving mucosal visibility can enhance diagnostic accuracy.
• Pronase, a protease enzyme, has been investigated for its potential to aid endoscopic procedures.

Purpose of the Study:

• To evaluate if pronase premedication enhances mucosal visualization during endoscopy.
• To determine if pronase premedication increases the detection rates of precancerous and cancerous lesions.
• To compare the efficacy of pronase versus water premedication in an endoscopic setting.

Main Methods:

• A randomized controlled trial involving 13 hospitals from June 2018 to April 2019.
• Outpatients scheduled for endoscopy were allocated to receive either pronase or water premedication (2:1 ratio).
• Primary endpoint: mucosal visibility scores; Secondary endpoints: precancerous and cancer lesion detection rates.

Main Results:

• Pronase premedication (Group A) resulted in significantly better mucosal visibility in the esophagus, stomach, and duodenum compared to water (Group B) (P <0.001).
• No significant difference was observed in overall cancer detection rates (0.83% vs 1.08%) or precancerous and cancer lesion detection rates (4.4% vs 4.9%).
• Pronase significantly reduced flushing volume (10.52±23.41 mL vs 36.30±52.11 mL) and frequency (0.46±1.01 vs 1.62±2.12) (P <0.001).

Conclusions:

• Premedication with pronase improves mucosal visibility during endoscopy.
• Pronase premedication effectively reduces the need for flushing during endoscopic procedures.
• Pronase does not appear to significantly increase the detection rates of precancerous or cancerous lesions.