Background To compare mucosal visibility between upper gastrointestinal endoscopies done with and without a premixed drink containing N acetyl cysteine and simethicone.

Methods It was a prospective, investigator-blind study where 43 consecutive patients reporting to our endoscopy center for screening upper GI endoscopy were randomly assigned into two groups containing 21 and 22 subjects and were assigned as standardized and nonstandardized groups, respectively. A pre-endoscopy drink containing Simethicone and N-acetyl cysteine (NAC) mixed with 100 ml of water was given to subjects in the standardized group 20-30 minutes before the procedure, while endoscopies in the nonstandardized group were done without any pre-drink, which only had to have mandatory fasting of at least 6-8 hours. During the procedure, mucosal visibility was noted and recorded by a blinded investigator who took digital images of six landmarks, which were assessed on a 3-point scale of visibility in both groups. The mean visibility scores were then compared between the two groups.

Results Mucosal visibility on endoscopy was significantly better in every part of the upper gastrointestinal tract that was studied in the standardized group compared to the nonstandardized one after using the pre-endoscopy drink. Mean visibility scores were 1.19 vs 2.13 (p < 0.05) in fundus, 1.43 vs 2.40 (p < 0.05) in proximal body, 1.62 vs 2.32 (p < 0.05) in distal body, 1.28 vs 2.18 (p < 0.05) in antrum, 1.09 vs 1.63 (p < 0.05) in first part of duodenum and 1.00 vs 1.18 (p < 0.05) in second part of duodenum. No adverse events related to this pre-endoscopy drink were seen.

Conclusions Offering Endoscopy pre-drink containing simethicone and NAC to patients should be made a part of UGI endoscopy standardization protocol for better mucosal visualization. Moreover, its easy availability, safety, and cost-effectiveness make it an ideal choice even in resource-limited settings across the globe for optimal endoscopy outcomes.