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Shutian Zhang - One of the best experts on this subject based on the ideXlab platform.
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efficacy and safety of using Premedication with simethicone pronase during upper gastrointestinal endoscopy examination with sedation a single center prospective single blinded randomized controlled trial
Digestive Endoscopy, 2018Co-Authors: Lingye Zhang, Wenyan Li, Ming Ji, Guangyong Chen, Shanshan Wu, Huihong Zhai, Shutian ZhangAbstract:Objectives To investigate the efficacy and safety of Premedication with simethicone/pronase during esophagogastroduodenoscopy (EGD) with sedation. Methods 610 patients were randomly allocated to two groups based on the type of Premedication given. The Premedication used in the control group was 10ml of lidocaine hydrochloride mucilage (LHM, N=314) and the Premedication used in the intervention group was 80mL of simethicone/pronase solution plus 10ml of lidocaine hydrochloride mucilage (SP/LHM, N=296). The EGD was performed under sedation. The visibility scores, number of mucosal areas that need to be cleansed, water consumption for cleansing, time taken for the examination, diminutive lesion, pathological diagnosis, patients’ gag reflex and the oxygenation (pulse oximetry) were recorded. Results The SP/LHM has significantly lower total visibility score than the LHM (7.978±1.526 vs 6.348±1.097, p<0.01). During the procedure, the number of intragastric area that needed to be cleansed and water consumption were significantly lesser in the SP/LHM than in the LHM (p<0.01). In the SP/LHM (p=0.01), the endoscopy procedure duration was significantly longer. Although there was no significant difference of the rate of detection of diminutive lesion between LHM and SP/LHM, the endoscopist performed more biopsies in the SP/LHM. This in turn leads to higher rate of diagnosis of atrophic gastritis (p =0.014) and intestinal metaplasia (p =0.024). There was no significant difference in gag reflex (p=0.604) and oxygenation during the endoscopy procedure for both group of patients. Conclusion The routine use of Premedication with Simethicone/Pronase should be recommended during EGD with sedation. This article is protected by copyright. All rights reserved.
Chiaohsiung Chuang - One of the best experts on this subject based on the ideXlab platform.
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a defoaming agent should be used with pronase Premedication to improve visibility in upper gastrointestinal endoscopy
Endoscopy, 2002Co-Authors: Bor-shyang Sheu, C.h. Wu, Chiaohsiung ChuangAbstract:BACKGROUND AND STUDY AIMS: The study tested whether pronase can improve endoscopic visibility and alter the accuracy of the CLO test for H. pylori detection. PATIENTS AND METHODS: A total of 160 patients were randomly assigned to receive one of five Premedications for endoscopy: group A: dimethylpolysiloxane (DMPS) alone; group B: DMPS plus water (up to 100 ml); group C: pronase only, with 100 ml water; group D: pronase and sodium bicarbonate plus water up to 100 ml; group E: pronase, sodium bicarbonate, and DMPS, plus water up to 100 ml. Endoscopists, who were unaware of the Premedication method administered, assessed visibility scores (range 1 - 4) for the antrum, lower gastric body, upper gastric body, and fundus. The higher the score, the less clear the visibility. The sum of scores from the four locations was defined as the total visibility score. A CLO test was also done during the endoscopy. One week after their endoscopy, patients in groups C, D, and E were scheduled for a (13)C-urea breath test (UBT). RESULTS: Group E patients had a significantly lower total visibility score than those in the other four groups ( P < 0.05). Groups C and D had higher total visibility scores than the other three groups ( P < 0.05). The scores did not significantly differ between groups A and B. Based on the UBT results, the sensitivity and specificity of the CLO test were 92.6 % and 96.2 %, respectively. CONCLUSIONS: Premedication as in group E provided the clearest endoscopic visibility. Without the application of DMPS, pronase alone cannot improve endoscopic visibility. Pronase does not influence H. pylori identification using the CLO test.
Guiqi Wang - One of the best experts on this subject based on the ideXlab platform.
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effect of Premedication on lesion detection rate and visualization of the mucosa during upper gastrointestinal endoscopy a multicenter large sample randomized controlled double blind study
Surgical Endoscopy and Other Interventional Techniques, 2018Co-Authors: Xiao Liu, C T Guan, Liyan Xue, Y Zhang, D L Zhao, F G Liu, Y F Liu, A S Ling, Wenqiang Wei, Guiqi WangAbstract:Premedication in upper gastrointestinal endoscopy for higher lesions detection rate has not been well studied so far. This study aimed to confirm whether Premedication could improve the detection rate of early cancer or precancerous lesions and mucosal visibility. From July 2015 to December 2015, 7200 participants from 6 centers were screened by endoscopy with one of the 4 following Premedications randomly: (1) water (group D); (2) pronase (group A); (3) simethicone (group B); (4) pronase and simethicone (group C). Early cancer and precancerous lesions detection rates were taken as the primary endpoints, and mucosal visibility was taken as the secondary endpoint. They were compared among four groups to determine different Premedication effects in terms of different anatomical sites. Trial was registered at Chinese Clinical Trial Registry; the registration number is ChiCTR-IOR-17010985. The upper gastrointestinal overall precancerous lesion detection rates among four groups were 8.7, 8.4, 10.0, and 10.3%, the overall early cancer detection rates were 1.3, 1.4%, 1.5, and 1.6%, both without significant difference (p = 0.138 and 0.878). However, the visibility score distributions between control group (D) and Premedication groups (A, B, and C) were all statistically significant, with all anatomical sites p values < 0.001. Subgroup analyses, from 2 centers without screening before, also showed significant difference in esophageal (3.9, 3.3, 4.5, and 8.4% with p = 0.004) and overall (7.0, 5.5, 7.3, and 12.0% with p = 0.004) precancerous lesion detection rate. Premedication with pronase and simethicone may not increase lesion detection rates but could significantly increase the upper gastrointestinal mucosal visibility.
Oki Kwon - One of the best experts on this subject based on the ideXlab platform.
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is clopidogrel Premedication useful to reduce thromboembolic events during coil embolization for unruptured intracranial aneurysms
Neurosurgery, 2010Co-Authors: Hyunseung Kang, Moon Hee Han, Bae Ju Kwon, Cheolkyu Jung, Jeong Eun Kim, Oki KwonAbstract:BACKGROUND: Thromboembolism is a common complication related to coil embolization of intracranial aneurysms. OBJECTIVE: To identify factors related to thromboembolic events during coil embolization for unruptured intracranial aneurysms and to evaluate the role of clopidogrel Premedication to prevent thromboembolisms. METHODS: Since March 2006, clopidogrel has been administered to patients with unruptured aneurysms before coil embolization (the clopidogrel group) in our institution. The clopidogrel group (416 patients with 485 aneurysms) and the historical control group (140 patients with 159 aneurysms who received no antiplatelet Premedication) were compared to find the efficacy of clopidogrel Premedication. Various factors, including age, sex, body weight, and medical history of hypertension, diabetes mellitus, hyperlipidemia, smoking, previous stroke, and heart disease, as well as clopidogrel Premedication, were analyzed in relationship to the development of a procedure-related thromboembolism. RESULTS: Procedure-related thromboembolic events tended to occur less frequently in the clopidogrel group compared with the control group (7.4% vs 12.6%; P = .05), and clopidogrel Premedication could modify the risk in female patients from 11.1% to 5.2% (P = .04). The use of multiple logistic regression analysis identified clopidogrel Premedication (P =.03), smoking (P=.002), and hyperlipidemia (P = .02) as significant factors related to the formation of thromboembolism. CONCLUSION: Clopidogrel Premedication seems to have a beneficial effect in reducing the number of procedure-related thromboembolisms during coil embolization for unruptured intracranial aneurysms, especially in female patients. Smoking and hyperlipidemia were independent risk factors related to thromboembolism.
Hsuanwei Chen - One of the best experts on this subject based on the ideXlab platform.
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efficacy of simethicone and n acetylcysteine as Premedication in improving visibility during upper endoscopy
Journal of Gastroenterology and Hepatology, 2014Co-Authors: Weikuo Chang, Mingkung Yeh, Hsuangchun Hsu, Hsuanwei ChenAbstract:Summary Background Simethicone and N-acetylcysteine have been widely used in improving endoscopic visibility. However, the optimal dose, volume, and dosing time for the Premedication regimen are still unclear. Aim Our aim was to assess the efficacy of Premedication in improving endoscopic visibility and determine the contributions of dose, volume, and Premedication time. Methods A total of 1849 patients were prospectively treated in three groups: group A: 100-mg simethicone suspension in 5 mL water; group B: 100-mg simethicone suspension in 100 mL water; and group C: 100-mg simethicone suspension in 100 mL water containing 200 mg N-acetylcysteine. Mucosa visibility was assessed at seven sites of upper gastrointestinal tract. The sum of scores was considered as total mucosal visibility score (TMVS). Results The upper body of stomach had the worst visibility score for all groups. TMVS of groups B and C were significantly lower than those of group A. Group C had a significantly fewer patients requiring endoscopic flushing than groups A and B. The TMVS for groups B and C were significantly lower than for group A within 30 min of beginning Premedication. Beyond 30 min of Premedication, there was no significant difference in the TMVS among groups. Conclusions Premedication using 100 mg simethicone in 100 mL of water improves endoscopic visibility. Addition of N-acetylcysteine to simethicone in 100 mL of water reduces the need for endoscopic flushing. For patients unable to tolerate a large fluid volume, a 5-mL simethicone suspension administered more than 30 min prior to upper endoscopy is suggested.
