Improving the mucosal visualization at gastroscopy: a systematic review and meta-analysis of randomized, controlled trials reporting the role of Simethicone ± N-acetylcysteine

Abstract

Background: The objective of this article is to study the role of Simethicone ± N-acetylcysteine in improving the mucosal visualization during oesophago-gastro-duodenoscopy (OGD).

Methods: The data retrieved from the published randomized controlled trials (RCTs) reporting the role of Simethicone ± N-acetylcysteine during OGD was analysed using the principles of meta-analysis. The summated outcome of continuous variables was expressed as standardized mean difference (SMD) and dichotomous data was presented in odds ratio (OR).

Results: Three RCTs on 654 patients reported OGD with and without pre-procedure oral administration of Simethicone ± N-acetylcysteine evaluating visibility as good or excellent in number during the procedure. In the random effects model analysis using the statistical software Review Manager 5.3, the use of Simethicone ± N-acetylcysteine was associated with improved (OR, 0.43; 95% CI, 0.28, 0.68; z=3.65; P=0.0003) mucosal visibility. Four RCTs on 364 patients reported OGD with and without pre-procedure oral administration of Simethicone ± N-acetylcysteine evaluating visibility score in study group. In the random effects model analysis using the statistical software Review Manager 5.3, the use of Simethicone ± N-acetylcysteine was associated with improved (SMD, -1.66; 95% CI, -1.93, -1.40; z=12.25; P=0.00001) mucosal visibility score compared to no-Simethicone group.

Conclusions: The findings of current study on 1,099 patients successfully demonstrate that the pre-procedure oral administration of Simethicone ± N-acetylcysteine improves mucosal visualization and mucosal visualization score during OGD.

Keywords: Oesophago-gastro-duodenoscopy (OGD); gastroscopy; mucosal visualization; mucous bubbles; mucus froth.

Conflict of interest statement

Conflicts of Interest: The abstract of this article has been accepted for presentation at the Annual General Meeting of the Associations of Surgeons of Great Britain and Ireland in Liverpool on 9th–11th May 2018. It will be published in the Supplement issue of the British Journal of Surgery.

Figures

Figure 1

PRISMA flow diagram.

Figure 2

GRADEPro summary of evidence. ⊕, level of evidence.

Figure 3

Forest plot for the studies reporting mucosal visibility score in patients undergoing OGD. Standardized mean difference is shown with 95% confidence intervals. OGD, oesophago-gastro-duodenoscopy.

Figure 4

Forest plot for the studies reporting number of patients with good/excellent mucosal visibility in patients undergoing OGD. Odds ratio is shown with 95% confidence intervals. OGD, oesophago-gastro-duodenoscopy.