Effectiveness of premedication with pronase for improving visibility during gastroendoscopy: a randomized controlled trial

doi:10.1016/S0016-5107(98)70223-8

Gastrointestinal Endoscopy

Volume 47, Issue 5, May 1998, Pages 382-387

https://doi.org/10.1016/S0016-5107(98)70223-8 Get rights and content

Abstract

Background: Minute early gastric cancers can be removed with endoscopic mucosal resection techniques. However, early detection of these minute cancers with endoscopy is still difficult. For this purpose, use of a dye is helpful. To increase visibility further, gastric mucus should be removed before endoscopic examination. In this study, the effectiveness of premedication with pronase for improving visibility during gastroendoscopy was investigated. Methods: From January through July 1996, outpatients scheduled for gastroendoscopy were randomly assigned to oral premedication with the antifoam agent dimethylpolysiloxane alone (n = 34), with dimethylpolysiloxane plus sodium bicarbonate (n = 32), or with dimethylpolysiloxane, sodium bicarbonate, and pronase (n = 34). All were given about 10 minutes before the start of endoscopy. After inserting the endoscope, the endoscopist gave visibility scores at conventional endoscopy and after methylene blue spraying. Results: Premedication with pronase significantly improved visibility before and after methylene blue spraying as compared with the two other groups pretreated without pronase. Pronase also significantly shortened the times for chromoendoscopic examination. Pronase had no significant effect on the culture of Helicobacter pylori. Conclusion: Premedication with pronase improved endoscopic visualization during conventional endoscopy and chromoendoscopy. Its routine use at gastroendoscopy is therefore recommended. (Gastrointest Endosc 1998; 47:382-7.)

Section snippets

Patients

From January through July 1996, 105 consecutive patients referred to our department for diagnostic upper gastrointestinal endoscopy were included in this study. Patients who had been referred for emergency gastroscopy or who had a stenosis of the upper gastrointestinal tract were not included.

Premedication and endoscopic procedure

After informed consent was obtained, patients were randomized using the sealed envelope technique to swallow one of the following three oral liquid solutions: solution A: 100 mL of warm water containing 80

RESULTS

Thirty-five patients were enrolled in each of the three groups in the trial. However, five patients were withdrawn: one patient (premedication with B) refused endoscopy and in four (one premedication with A, two premedication with B, and one premedication with C) chromoendoscopic examination could not be performed because of anxiety and inability to cooperate for the procedure. (In this series no patients received a sedative for endoscopy.)

There were no significant differences among the three

DISCUSSION

Proper premedication before endoscopy is important to ensure satisfactory visualization of the gastric wall, especially before chromoendoscopy.5, 6, 7 In the present work, we found that premedication with pronase significantly improved the visibility of the gastric wall during conventional endoscopy and after methylene blue spraying. Pronase premedication also significantly shortened the duration of endoscopy because it eliminates the need to awkwardly manipulate a wash tube during the

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Citation Excerpt :
Pronase contains several proteolytic enzymes which degrade gastric mucus and is used with simethicone in some countries prior to gastroscopy. Several studies have shown that pronase [17–19] and other mucolytics, N-acetylcysteine [24] and dimethylpolysiloxane [28] improved the visibility of the gastric wall during conventional endoscopy. However, oral pronase administration did not augment the effect compared with simethicone alone in the present study.
Magnetically controlled capsule endoscopy (MCE) is a novel technique for which there is no agreed gastric preparation. We aimed to determine an optimal standardized gastric preparation regimen.
120 patients referred for MCE were randomly assigned to gastric preparation with either water alone (A), water with simethicone (B) or water, simethicone and pronase (C). Image quality was assessed using cleanliness and visualization scores, higher scores equating to better image quality.
The total cleanliness scores were (mean ± SD) 15.83 ± 2.41 (A), 21.35 ± 1.23 (B), and 20.82 ± 1.90 (C). The total visualization scores (mean ± SD) were 10.75 ± 2.02 (A), 15.20 ± 1.32 (B), and 15.08 ± 1.86 (C). While the image quality of the whole stomach in groups B and C were significantly better than group A (P < 0.0001), there was no statistical difference between group B and C (P > 0.05). MCE detected positive findings in 21 (52.5%), 27 (67.5%) and 21 (53.8%) patients in group A, B and C respectively, with no significant difference between groups (P > 0.5).
Simethicone swallowed with water prior to MCE produced the optimal gastric mucosal image quality. The addition of pronase had no demonstrable additional benefit.
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^☆: From the Departments of Nursing and Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.

^☆☆: Reprint requests: Hiroyasu Iishi, MD, Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases. 3-3, Nakamichi 1-chome, Higashinari-ku, Osaka 537-8511, Japan.

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Effectiveness of premedication with pronase for improving visibility during gastroendoscopy: a randomized controlled trial☆,☆☆

Abstract

Section snippets

Patients

Premedication and endoscopic procedure

RESULTS

DISCUSSION

Gastrointest Endosc

Effectiveness of preprocedure simethicone drink in improving visibility during esophagogastroduodenoscopy: a double-blind, randomized study

J Clin Gastroenterol

The bubble problem in endoscopy

Gastrointest Endosc

Significance of strip biopsy, with special reference to endoscopic “mucosectomy.”

Dig Endosc

Endoscopic diagnosis of gastric cancer with dye scattering

Am J Gastroenterol

An endoscopic staining method for detection and operation of early gastric cancer

Int Adv Surg Oncol