title: Endoscopic flushing with pronase improves the quantity and quality of gastric biopsy: a prospective study.
abstract: OBJECTIVE
  Pronase, a proteolytic enzyme, is known to improve mucosal visibility during esophagogastroduodenoscopy (EGD), but little is known about its effects on gastric biopsy. This study assessed whether endoscopic flushing with pronase improves the quality of gastric biopsy.
  
  
  METHODS
  Consecutive patients who underwent EGD were randomly assigned to either the control group or the pronase group in a prospective setting. The first biopsy of the identified lesion was performed during endoscopy. Endoscopic flushing with either 50 mL of water and dimethylpolysiloxane (DMPS; control group) or 50 mL of water, pronase, sodium bicarbonate, and DMPS (pronase group) was then applied to the lesion. After 5 minutes, the second biopsy was performed 2 - 3 mm away from the first biopsy site. The thickness of mucus, depth of the specimen, overall diagnostic adequacy, anatomical orientation, and crush artifact were measured to assess the quality of the biopsy.
  
  
  RESULTS
  Of the 208 patients, 10 were not analyzed due to the absence of an identifiable lesion. Compared with the control group, the pronase group showed significantly decreased thickness of mucus (P < 0.001), increased depth of biopsy (P < 0.001), improved anatomical orientation (P = 0.010), and improved overall diagnostic assessment (P = 0.011) in the second biopsied specimen following endoscopic flushing. The crush artifact and hemorrhage did not differ between the groups.
  
  
  CONCLUSIONS
  Endoscopic flushing with pronase not only improved the depth of biopsy but also the anatomical orientation and overall diagnostic adequacy. Pronase can be recommended for flushing during EGD to improve the quantity and quality of biopsy.
authors.affiliation: Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Sun-Young
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Pathology, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hye S
authors.initials: HS
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, University of Kyunghee College of Medicine, Seoul, Republic of Korea.
authors.forename: Jae M
authors.initials: JM
authors.lastname: Cha
authors.affiliation: Department of Internal Medicine, The Catholic University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yu K
authors.initials: YK
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.
authors.forename: Gwang H
authors.initials: GH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.
authors.forename: Il-Kwun
authors.initials: IK
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000592:standards*; D005260:Female; D005751:Gastric Lavage / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011402:Pronase / Q000008:administration & dosage*; D011446:Prospective Studies; D013272:Stomach Diseases / Q000473:pathology*
chemical_list: D011402:Pronase