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Premedication in upper gastrointestinal endoscopy to improve mucosal visualization. A systematic review
Juan David Linares-Ramírez1, Andrea Carolina Córdoba1, Carlos Hernán Calderón-Franco1
1Department of Gastroenterology and Endoscopy, Colombia University Clinic, Bogotá, Colombia.
Summary
Premedication with simethicone significantly improves visualization during upper GI endoscopy. This safe and effective agent enhances the endoscopic procedure, though other agents showed no significant benefit.
Area of Science:
- Gastroenterology
- Endoscopy
- Pharmacology
Background:
- Upper gastrointestinal endoscopy (upper GI endoscopy) quality is often limited by poor visualization due to mucus.
- Premedication with mucolytics and defoaming agents is proposed to enhance visualization.
Purpose of the Study:
- To evaluate the efficacy and safety of premedication with mucolytics and/or defoaming agents for improving visualization during elective upper GI endoscopy.
Main Methods:
- Systematic review of randomized controlled trials and systematic reviews from Medline/Pubmed, Embase, and Lilacs.
- Meta-analysis to assess the efficacy and safety of premedication agents for mucous clearance.
Main Results:
- Defoaming and/or mucolytic agents improved gastric antrum visibility during elective upper GI endoscopy.
- Simethicone and N-acetyl cysteine (NAC) showed significant improvement compared to water.
- No significant differences were found between simethicone alone and simethicone + NAC; other agents showed no significant additive effect.
Conclusions:
- Simethicone is safe and effective for improving visualization in elective upper GI endoscopy.
- No significant visualization improvement was noted with other agents or combinations.
- Off-label use of simethicone is recommended at prescriber's discretion to enhance endoscopic visualization.
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