A randomized, controlled study on the use of antifoaming and mucolytic agents in preparation for upper digestive endoscopy

Abstract Background The randomized, controlled, double-blind study aimed to compare solutions containing antifoaming agent alone vs. antifoaming agent combined with mucolytic agent for improving endoscopic visibility to determine the most appropriate and effective solution for use in practical clinic. Methods A total of 178 adult individuals undergoing routine upper gastrointestinal endoscopy were divided into three groups to receive pre-endoscopic solutions: group A - Simethicone 100mg (Simet) + N-acetylcysteine 600mg (NAC) + water; group B - Simethicone 100mg + water; and group C (Control) - 100mL water. Mucosal visibility was assessed at four sites in the upper gastrointestinal tract (lower oesophagus, body, antrum and gastric fundus), and the sum of the scores was considered the total mucosal visibility score. The visibility scores were compared between the solutions. The total duration of the procedure, the volume of water required to obtain adequate vision and the mean time of administration of pre-endoscopic solutions were compared between groups. The likelihood of obtaining better visibility scores for each segment was evaluated in relation to the type of solution and the administrations times. Results The mean total visibility score of solution B was better than that of solution C. The mean antral score was better for solutions A and B than for solution C and the mean fundus score was better for solution B than for solution C. There was no significant difference between solutions A and B. Despite not demonstrating clear benefits, the combination of NAC with simethicone was superior to that of the placebo in the antrum. The duration of the exam and the volume of water required to improve visibility were similar between the solutions. There was a greater chance of obtaining better visibility scores when using solution B for 10-20 minutes in all segments. Conclusion The use of simethicone alone as a pre-endoscopic solution improved the visibility of the gastric mucosa, notably of the antrum and fundus when administered 10-20 minutes before the exam. The addition of NAC to the antifoaming agent did not improve mucosal visibility. Trial registration: Research Ethics Committee of the Institute for Strategic Health Management of the Federal District (CAAE 31061420.6.0000.8153).