Simethicone and N-acetylcysteine in Upper Endoscopy - Prospective Double-blinded Randomized Controlled Trial

NCT ID: NCT02357303

Last Updated: 2016-01-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-04-30

Study Completion Date

2016-01-31

Brief Summary

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The upper endoscopy is one of the most common methods for the diagnosis and treatment of upper gastrointestinal (GI) tract diseases and provides a unique opportunity to identify early neoplastic lesions.

Before an upper endoscopy it is required a 6 hour fasting period\[1\]. However, even with this fasting period, sometimes the mucosal visualization, especially in the stomach, is impaired by the presence of foam, bubbles or gastric mucus.

To improve visualization of the gastric mucosa, it is possible to administrate an oral solution of defoaming agents such as Simethicone and mucolytic agents like Pronase or N-Acetylcysteine previously to the procedure.

The aim of this project is to determine if the use of premedication with simethicone, alone or in association with N-Acetylcysteine, improves mucosal visualization during an upper GI endoscopy.

Detailed Description

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a. Study type: prospective, randomized, double-blinded, placebo-controlled trial: i. Prospective inclusion of patients; ii. Randomization by computer generated tables; iii. Allocation concealment by sealed, opaque envelopes; iv. Double-blinded - nurse instructed not to reveal treatment; patient and doctor unaware of treatment;

b. Patient selection: consecutive series of patients scheduled for upper gastrointestinal endoscopy; Exclusion criteria - sedation, previous total gastrectomy, known neoplasia or stenosis, allergies to simethicone or N-acetylcysteine, therapeutic or urgent procedures;

c. Sample size: 270 (3 groups of 90 patients): to improve "excellent" preparations from 20% (value from our own database) to 40% and assuming a normal distribution and a power of 80% (α=0.05), the calculated sample size of each of the 3 groups was 82; allowing for a 10% dropout rate, the sample size is 90 (270 patients overall); Groups: Group A - 100mL of water (placebo); Group B - 100mL of water plus 100mg Simethicone; Group C - 100mL of water plus 100mg Simethicone plus 600mg N-acetylcysteine;

d. Data collection methods: form sheet filled by nurses (appendix 1) and endoscopist (appendix 2);

e. Analysed variables: patients characteristics (age, gender), indication for endoscopy, time from administration to procedure, score of mucosal visualization, side effects of medication;

f. Statistical analysis: chi-square test.

Conditions

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Gastric Mucosal Lesion

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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Placebo

Group A - 100mL of water by mouth, 15 to 30 minutes before endoscopy

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type OTHER

100mL of water

Simethicone

Group B - 100mL of water plus 100mg Simethicone by mouth, 15 to 30 minutes before endoscopy

Group Type ACTIVE_COMPARATOR

Simethicone

Intervention Type DRUG

100mL of water plus 100mg Simethicone by mouth, 15 to 30 minutes before endoscopy

Simethicone plus N-acetylcysteine

Group C - 100mL of water plus 100mg Simethicone plus 600mg N-acetylcysteine by mouth, 15 to 30 minutes before endoscopy

Group Type ACTIVE_COMPARATOR

Acetylcysteine

Intervention Type DRUG

100mL of water plus 100mg Simethicone plus 600mg N-acetylcysteine by mouth, 15 to 30 minutes before endoscopy

Interventions

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Simethicone

100mL of water plus 100mg Simethicone by mouth, 15 to 30 minutes before endoscopy

Intervention Type DRUG

Acetylcysteine

100mL of water plus 100mg Simethicone plus 600mg N-acetylcysteine by mouth, 15 to 30 minutes before endoscopy

Intervention Type DRUG

Placebo

100mL of water

Intervention Type OTHER

Other Intervention Names

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Aero-OM Fluimucil

Eligibility Criteria

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Inclusion Criteria

* consecutive series of patients scheduled for upper gastrointestinal endoscopy
* signed informed consent

Exclusion Criteria

* sedation
* previous total gastrectomy
* known neoplasia or stenosis
* therapeutic or urgent procedures
* allergies to simethicone or N-acetylcysteine
Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Portuguese Oncology Institute, Coimbra

OTHER

Sponsor Role lead

Responsible Party

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Luís André Caio Elvas

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Luís Elvas, MD

Role: PRINCIPAL_INVESTIGATOR

Gastroenterology Department, Portuguese Oncology Institute - Coimbra

Locations

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Portuguese Oncology Institute - Coimbra

Coimbra, Coimbra District, Portugal

Site Status

Countries

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Portugal

References

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Faigel DO, Eisen GM, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, Jacobson BC, Johanson JF, Leighton JA, Mallery JS, Raddawi HM, Vargo JJ 2nd, Waring JP, Fanelli RD, Wheeler-Harbough J; Standards of Practice Committee. American Society for Gastrointestinal Endoscopy. Preparation of patients for GI endoscopy. Gastrointest Endosc. 2003 Apr;57(4):446-50. doi: 10.1016/s0016-5107(03)80006-8. No abstract available.

Reference Type BACKGROUND
PMID: 12665751 (View on PubMed)

Asl SM, Sivandzadeh GR. Efficacy of premedication with activated Dimethicone or N-acetylcysteine in improving visibility during upper endoscopy. World J Gastroenterol. 2011 Oct 7;17(37):4213-7. doi: 10.3748/wjg.v17.i37.4213.

Reference Type BACKGROUND
PMID: 22072853 (View on PubMed)

Chen MJ, Wang HY, Chang CW, Hu KC, Hung CY, Chen CJ, Shih SC. The add-on N-acetylcysteine is more effective than dimethicone alone to eliminate mucus during narrow-band imaging endoscopy: a double-blind, randomized controlled trial. Scand J Gastroenterol. 2013 Feb;48(2):241-5. doi: 10.3109/00365521.2012.749509. Epub 2012 Dec 27.

Reference Type BACKGROUND
PMID: 23268593 (View on PubMed)

Bhandari P, Green S, Hamanaka H, Nakajima T, Matsuda T, Saito Y, Oda I, Gotoda T. Use of Gascon and Pronase either as a pre-endoscopic drink or as targeted endoscopic flushes to improve visibility during gastroscopy: a prospective, randomized, controlled, blinded trial. Scand J Gastroenterol. 2010 Mar;45(3):357-61. doi: 10.3109/00365520903483643.

Reference Type BACKGROUND
PMID: 20148732 (View on PubMed)

Ahsan M, Babaei L, Gholamrezaei A, Emami MH. Simethicone for the Preparation before Esophagogastroduodenoscopy. Diagn Ther Endosc. 2011;2011:484532. doi: 10.1155/2011/484532. Epub 2011 Aug 4.

Reference Type BACKGROUND
PMID: 21826120 (View on PubMed)

Bertoni G, Gumina C, Conigliaro R, Ricci E, Staffetti J, Mortilla MG, Pacchione D. Randomized placebo-controlled trial of oral liquid simethicone prior to upper gastrointestinal endoscopy. Endoscopy. 1992 May;24(4):268-70. doi: 10.1055/s-2007-1010479.

Reference Type BACKGROUND
PMID: 1612040 (View on PubMed)

Keeratichananont S, Sobhonslidsuk A, Kitiyakara T, Achalanan N, Soonthornpun S. The role of liquid simethicone in enhancing endoscopic visibility prior to esophagogastroduodenoscopy (EGD): A prospective, randomized, double-blinded, placebo-controlled trial. J Med Assoc Thai. 2010 Aug;93(8):892-7.

Reference Type BACKGROUND
PMID: 20718163 (View on PubMed)

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 Jul;34(7):531-4. doi: 10.1055/s-2002-33220.

Reference Type BACKGROUND
PMID: 12170403 (View on PubMed)

Lee GJ, Park SJ, Kim SJ, Kim HH, Park MI, Moon W. Effectiveness of Premedication with Pronase for Visualization of the Mucosa during Endoscopy: A Randomized, Controlled Trial. Clin Endosc. 2012 Jun;45(2):161-4. doi: 10.5946/ce.2012.45.2.161. Epub 2012 Jun 30.

Reference Type BACKGROUND
PMID: 22866258 (View on PubMed)

Fujii T, Iishi H, Tatsuta M, Hirasawa R, Uedo N, Hifumi K, Omori M. Effectiveness of premedication with pronase for improving visibility during gastroendoscopy: a randomized controlled trial. Gastrointest Endosc. 1998 May;47(5):382-7. doi: 10.1016/s0016-5107(98)70223-8.

Reference Type BACKGROUND
PMID: 9609431 (View on PubMed)

Zala G, Flury R, Wust J, Meyenberger C, Ammann R, Wirth HP. [Omeprazole/amoxicillin: improved eradication of Helicobacter pylori in smokers because of N-acetylcysteine]. Schweiz Med Wochenschr. 1994 Aug 9;124(31-32):1391-7. German.

Reference Type BACKGROUND
PMID: 8091167 (View on PubMed)

Chang CC, Chen SH, Lin CP, Hsieh CR, Lou HY, Suk FM, Pan S, Wu MS, Chen JN, Chen YF. Premedication with pronase or N-acetylcysteine improves visibility during gastroendoscopy: an endoscopist-blinded, prospective, randomized study. World J Gastroenterol. 2007 Jan 21;13(3):444-7. doi: 10.3748/wjg.v13.i3.444.

Reference Type BACKGROUND
PMID: 17230616 (View on PubMed)

Chang WK, Yeh MK, Hsu HC, Chen HW, Hu MK. Efficacy of simethicone and N-acetylcysteine as premedication in improving visibility during upper endoscopy. J Gastroenterol Hepatol. 2014 Apr;29(4):769-74. doi: 10.1111/jgh.12487.

Reference Type BACKGROUND
PMID: 24325147 (View on PubMed)

Elvas L, Areia M, Brito D, Alves S, Saraiva S, Cadime AT. Premedication with simethicone and N-acetylcysteine in improving visibility during upper endoscopy: a double-blind randomized trial. Endoscopy. 2017 Feb;49(2):139-145. doi: 10.1055/s-0042-119034. Epub 2016 Nov 16.

Reference Type DERIVED
PMID: 27852098 (View on PubMed)

Other Identifiers

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PortugueseOIC 001

Identifier Type: -

Identifier Source: org_study_id

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