Clin Endosc.  2012 Jun;45(2):161-164. 10.5946/ce.2012.45.2.161.

Effectiveness of Premedication with Pronase for Visualization of the Mucosa during Endoscopy: A Randomized, Controlled Trial

• Lee GJ
• Park SJ
• Kim SJ
• Kim HH
• Park MI
• Moon W

• KMID: 2048855
• DOI: http://doi.org/10.5946/ce.2012.45.2.161

Abstract

BACKGROUND/AIMS
Gastric mucus should be removed before endoscopic examination to increase visibility. In this study, the effectiveness of premedication with pronase for improving visibility during endoscopy was investigated.
METHODS
From April 2010 to February 2011, 400 outpatients were randomly assigned to receive endoscopy with one of four premedications as follows: dimethylpolysiloxane (DMPS), pronase and sodium bicarbonate with 10 minutes premedication time (group A, n=100), DMPS and sodium bicarbonate with 10 minutes premedication time (group B, n=100), DMPS, pronase and sodium bicarbonate with 20 minutes premedication time (group C, n=100), and DMPS and sodium bicarbonate with 20 minute premedication time (group D, n=100). One endoscopist, who was unaware of the premedication types, calculated the visibility scores (range, 1 to 3) of the antrum, lower gastric body, upper gastric body and fundus. The sum of the scores from the four locations was defined as the total visibility score.
RESULTS
Group C showed significantly lower scores than other groups (p=0.002). Group C also had the lowest frequency of flushing, which was significantly lower than that of group D. Groups C and D had significantly shorter durations of examination than groups A and B.
CONCLUSIONS
Using pronase 20 minutes before endoscopy significantly improved endoscopic visualization and decreased the frequency of water flushing.

Keyword

Pronase; Premedication

MeSH Terms

Dimethylpolysiloxanes
Endoscopy
Flushing
Humans
Mucous Membrane
Mucus
Outpatients
Premedication
Pronase
Sodium Bicarbonate
Unithiol
Dimethylpolysiloxanes
Pronase
Sodium Bicarbonate
Unithiol

Figure

• 

  Fig. 1 Mucosal visibility score. (A) Score 1, no adherent mucus and clear view of the mucosa. (B) Score 2, a thin coating of mucus without obscured vision. (C) Score 3, adherent mucus obscuring vision.

Reference

1. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011; 14:101–112. PMID: 21573743.

2. Shimizu S, Tada M, Kawai K. Early gastric cancer: its surveillance and natural course. Endoscopy. 1995; 27:27–31. PMID: 7601031.

3. Talley NJ, Silverstein MD, Agréus L, Nyrén O, Sonnenberg A, Holtmann G. AGA technical review: evaluation of dyspepsia. American Gastroenterological Association. Gastroenterology. 1998; 114:582–595. PMID: 9496950.

4. Borie F, Rigau V, Fingerhut A, Millat B. French Association for Surgical Research. Prognostic factors for early gastric cancer in France: Cox regression analysis of 332 cases. World J Surg. 2004; 28:686–691. PMID: 15383869.

5. Banerjee B, Parker J, Waits W, Davis B. Effectiveness of preprocedure simethicone drink in improving visibility during esophagogastroduodenoscopy: a double-blind, randomized study. J Clin Gastroenterol. 1992; 15:264–265. PMID: 1479177.

6. McDonald GB, O'Leary R, Stratton C. Pre-endoscopic use of oral simethicone. Gastrointest Endosc. 1978; 24:283. PMID: 365670.

7. Fujii T, Iishi H, Tatsuta M, et al. Effectiveness of premedication with pronase for improving visibility during gastroendoscopy: a randomized controlled trial. Gastrointest Endosc. 1998; 47:382–387. PMID: 9609431.

8. Koga M, Arakawa K. On the application of enzymatic mucinolysis in X-ray diagnosis of the stomach. Nihon Igaku Hoshasen Gakkai Zasshi. 1964; 24:1011–1031. PMID: 14280614.

9. Ida K, Okuda J, Nakazawa S, et al. Clinical evaluation of premedication with KPD (Pronase) in gastroendoscopy-placebo-controlled double blind study in dye scattering endoscopy. Clin Rep. 1991; 25:1793–1804.

10. Chang CC, Chen SH, Lin CP, et al. Premedication with pronase or N-acetylcysteine improves visibility during gastroendoscopy: an endoscopist-blinded, prospective, randomized study. World J Gastroenterol. 2007; 13:444–447. PMID: 17230616.

11. Kuo CH, Sheu BS, Kao AW, Wu CH, Chuang CH. A defoaming agent should be used with pronase premedication to improve visibility in upper gastrointestinal endoscopy. Endoscopy. 2002; 34:531–534. PMID: 12170403.