Effect of pronase as mucolytic agent on imaging quality of magnifying endoscopy.
OBJECTIVE
To investigate the efficacy of premedication with pronase, a proteolytic enzyme, in improving image quality during magnifying endoscopy.


METHODS
The study was of a blinded, randomized, prospective design. Patients were assigned to groups administered oral premedication of either pronase and simethicone (Group A) or simethicone alone (Group B). First, the gastric mucosal visibility grade (1-4) was determined during conventional endoscopy, and then a magnifying endoscopic examination was conducted. The quality of images obtained by magnifying endoscopy at the stomach and the esophagus was scored from 1 to 3, with a lower score indicating better visibility. The endoscopist used water flushes as needed to obtain satisfactory magnifying endoscopic views. The main study outcomes were the visibility scores during magnifying endoscopy and the number of water flushes.


RESULTS
A total of 144 patients were enrolled, and data from 143 patients (M:F=90:53, mean age 57.5 years) were analyzed. The visibility score was significantly higher in the stomach following premedication with pronase (73% with a score of 1 in Group A vs 49% in Group B, P<0.05), but there was no difference in the esophagus visibility scores (67% with a score of 1 in Group A vs 58% in Group B). Fewer water flushes [mean 0.7±0.9 times (range: 0-3 times) in Group A vs 1.9±1.5 times (range: 0-6 times) in Group B, P<0.05] in the pronase premedication group did not affect the endoscopic procedure times [mean 766 s (range: 647-866 s) for Group A vs 760 s (range: 678-854 s) for Group B, P=0.88]. The total gastric mucosal visibility score was also lower in Group A (4.9±1.5 vs 8.3±1.8 in Group B, P<0.01).


CONCLUSIONS
The addition of pronase to simethicone premedication resulted in clearer images during magnifying endoscopy and reduced the need for water flushes.
Gwang Ha Kim, Department of Internal Medicine, Pusan National University School of Medicine, Pusan 602-739, South Korea.
Gwang Ha
GH
Kim
Gwang Ha Kim, Department of Internal Medicine, Pusan National University School of Medicine, Pusan 602-739, South Korea.
Yu Kyung
YK
Cho
Gwang Ha Kim, Department of Internal Medicine, Pusan National University School of Medicine, Pusan 602-739, South Korea.
Jae Myung
JM
Cha
Gwang Ha Kim, Department of Internal Medicine, Pusan National University School of Medicine, Pusan 602-739, South Korea.
Sun-Young
SY
Lee
Gwang Ha Kim, Department of Internal Medicine, Pusan National University School of Medicine, Pusan 602-739, South Korea.
Il-Kwun
IK
Chung
D000934:Antifoaming Agents / Q000008:administration & dosage; D002681:China; D004311:Double-Blind Method; D004938:Esophageal Neoplasms / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology; D005100:Expectorants / Q000008:administration & dosage*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011402:Pronase / Q000008:administration & dosage*; D011446:Prospective Studies; D012841:Simethicone / Q000008:administration & dosage; D013274:Stomach Neoplasms / Q000473:pathology*; D007507:Therapeutic Irrigation
D000934:Antifoaming Agents; D005100:Expectorants; D012841:Simethicone; D011402:Pronase
Image enhancement; Narrow-band imaging, Endoscopy; Pronase; Randomized controlled trial