Abstract
BackgroundThe reformulated simethicone emulsion from Berlin Chemical AG might develop white flocculate precipitate covering the gastric mucosa when used before esophagogastroduodenoscopy (EGD). We aim to investigate whether combining the reformulated simethicone emulsion with 5% sodium bicarbonate solution could prevent the development of white precipitate and improve visibility during EGD.MethodsOur clinical study involved 523 patients. They were randomly assigned to two groups. In Group A, patients received a warm solution containing 30 ml 5% sodium bicarbonate solution and 15 ml reformulated simethicone emulsion. In Group B, patients received 45 ml 40 °C lukewarm water. Visibility scores were recorded and analyzed. Flushes, volume of flush water, overall time taken for EGD and complications during or after the procedure were also recorded.ResultsWe found that no white precipitate was observed during EGD in Group A. Moreover, visibility scores in Group A were significantly lower (P < 0.01). Patients in Group A had fewer flushes (P < 0.01) and smaller volume of flush water (P < 0.01). In addition, the overall time taken for the EGD procedure was significantly shorter in Group A (P < 0.01). The percentage of patients who had no adverse response was significantly higher in Group A than in Group B (P < 0.01).ConclusionsPremedication with a mixed solution of 15 ml reformulated simethicone emulsion and 30 ml 5% sodium bicarbonate solution can prevent the development of white precipitate, substantially enhancing mucosal visibility safely.Trial registration: The registered name of the trial is “Efficacy of using premedication with reformulated simethicone emulsion during upper gastrointestinal endoscopy examination”. Its Current Controlled Trials number is ChiCTR1900021689. Its date of registration is 11 September 2019. Retrospectively registered, http://www.medresman.org.cn/uc/sindex.aspx.
Highlights
The reformulated simethicone emulsion from Berlin Chemical AG might develop white flocculate precipitate covering the gastric mucosa when used before esophagogastroduodenoscopy (EGD)
Investigation of the stability of the reformulated simethicone emulsion mixed with different doses of sodium bicarbonate solution under acidic conditions in vitro When the reformulated simethicone emulsion was mixed with artificial gastric acid, white precipitate developed
In 10 ml of artificial gastric acid, a 1-ml or 1.2-ml sodium bicarbonate solution mixed with 3 ml reformulated simethicone emulsion developed a large amount of precipitate
Summary
The reformulated simethicone emulsion from Berlin Chemical AG might develop white flocculate precipitate covering the gastric mucosa when used before esophagogastroduodenoscopy (EGD). We aim to investigate whether combining the reformulated simethicone emulsion with 5% sodium bicarbonate solution could prevent the development of white precipitate and improve visibility during EGD. High-quality EGD examination will significantly increase the diagnostic rate of upper gastrointestinal disease, especially early or subtle lesions. The major technical obstacle lies in the presence of foam and mucus over the gastric mucosal surfaces, which often results in impaired visibility, prolonged examination time, aggravating discomfort for patients and even missed diagnoses of early or subtle lesions. It is generally accepted that premedication with antifoam/mucus agents before EGD can improve operation visibility [5,6,7]. The optimal quantity, density and time of premedication have not yet been established
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
