title: A randomized controlled trial of pre-procedure simethicone and N-acetylcysteine to improve mucosal visibility during gastroscopy - NICEVIS.
abstract: Background and study aims:Mucosal views can be impaired by residual bubbles and mucus during gastroscopy. This study aimed to determine whether a pre-gastroscopy drink containing simethicone and N-acetylcysteine improves mucosal visualisation.Patients and methods:We conducted a randomized controlled trial recruiting 126 subjects undergoing routine gastroscopy. Subjects were randomized 1:1:1 to receive: A-pre-procedure drink of water, simethicone and N-acetylcysteine (NAC); B-water alone; or C-no preparation. Study endoscopists were blinded to group allocation. Digital images were taken at 4 locations (lower esophagus/upper gastric body/antrum/fundus), and rated for mucosal visibility (MV) using a 4-point scale (1 = best, 4 = worst) by 4 separate experienced endoscopists. The primary outcome measure was mean mucosal visibility score (MVS). Secondary outcome measures were procedure duration and volume of fluid flush required to achieve adequate mucosal views.Results:Mean MVS for Group A was significantly better than for Group B (1.35 vs 2.11,P< 0.001) and Group C (1.35 vs 2.21,P< 0.001). Mean flush volume required to achieve adequate mucosal views was significantly lower in Group A than Group B (2.0 mL vs 31.5 mL,P= 0.001) and Group C (2.0 mL vs 39.2 mLP< 0.001). Procedure duration did not differ significantly between any of the 3 groups. MV scores at each of the 4 locations demonstrated significantly better mucosal visibility in Group A compared to Group B and Group C (P< 0.0025 for all comparisons).Conclusions:A pre-procedure drink containing simethicone and NAC significantly improves mucosal visibility during gastroscopy and reduces the need for flushes during the procedure. Effectiveness in the lower esophagus demonstrates potential benefit in Barrett's oesophagus surveillance gastroscopy.
authors.affiliation: Portsmouth Hospitals NHS trust - Endoscopy Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland; University of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Peter John
authors.initials: PJ
authors.lastname: Basford
authors.affiliation: University of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland.
authors.forename: James
authors.initials: J
authors.lastname: Brown
authors.affiliation: Portsmouth Hospitals NHS trust - Endoscopy Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gadeke
authors.affiliation: University of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Carole
authors.initials: C
authors.lastname: Fogg
authors.affiliation: University of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Ben
authors.initials: B
authors.lastname: Haysom-Newport
authors.affiliation: University of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Reuben
authors.initials: R
authors.lastname: Ogollah
authors.affiliation: Portsmouth Hospitals NHS Trust - Gastroenterology, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Rupam
authors.initials: R
authors.lastname: Bhattacharyya
authors.affiliation: Portsmouth Hospitals NHS trust - Endoscopy Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland; University of Portsmouth - Pharmacy and Biomedical Sciences, Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Gaius
authors.initials: G
authors.lastname: Longcroft-Wheaton
authors.affiliation: Portsmouth Hospitals NHS trust - Endoscopy Portsmouth, Hampshire, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Fergus
authors.initials: F
authors.lastname: Thursby-Pelham
authors.affiliation: South Devon Healthcare NHS Foundation Trust - Gastroenterology, Torquay, Torbay, United Kingdom of Great Britain and Northern Ireland.
authors.forename: James R
authors.initials: JR
authors.lastname: Neale
authors.affiliation: Portsmouth Hospital - Endoscopy, Portsmouth, West Sussex, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bhandari