Abstract
INTRODUCTION: Pronase is a proteolytic enzyme that helps in removal of mucous when used during the endoscopic examination by mucolytic activity. The increase in visibility during upper endoscopy and endoscopic ultrasound examination leads to identification of early cancerous lesions in the stomach.Different studies have reported varied results for using pronase as a pre-medication to improve visibility. We conducted a systematic review and meta-analysis to assess the improvement in visibility after pre-medication with Pronase in Upper endoscopy. METHODS: We performed a systematic search of multiple databases through May 2019 to identify studies reporting on the use of Pronase and outcomes in terms of visibility scores in upper endoscopy. Pooled visibility scores for different parts of the stomach were obtained. Heterogeneity was assessed by I2 statistics. RESULTS: Seven studies with a total of 2431 patients were included in the final analysis. The mean age ranged from 47 to 61 years with 44% males. majority of the studies were based out of single center data. The dose of pronase used was 20000 units in majority of the studies. Medication administration time varied. Four studies administered pronase 10 minutes before procedure, three studies administered it 20 minutes before procedure and one study used it 30 min before the procedure. Visibility scoring was done based on a scale of 1 to 4, 1 being best possible visualization. The pooled visibility score for the gastric antrum with pronase was 1.42 (95% CI: 1.2-1.6, I2 = 99); for fundus was 1.17 (95% CI: 1.1-1.2, I2 = 67.5); for lower gastric body was 1.46 (95% CI: 1.3-1.7, I2=94.5); and for upper gastric body was 1.68 (95% CI: 1.4-2, I2 = 97.3). Significant heterogeneity was noted in the analysis. CONCLUSION: Based on this meta-analysis the pooled visibility scores appear to be near one which is the ideal score.The optimal time of administration (pre-procedure drink or intraprocedural flushes) and the effect of pronase in improving detection of early cancerous lesion should be determined in future well controlled large studies.
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