Clinical Endoscopy

Original Article

Effectiveness of Premedication with Pronase for Visualization of the Mucosa during Endoscopy: A Randomized, Controlled Trial: Gyu Jin Lee, Seun Ja Park, Sun Jung Kim, Hyung Hun Kim, Moo In Park, Won Moon; Clin Endosc 2012;45(2):161-164. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.161

Background/Aims

Gastric mucus should be removed before endoscopic examination to increase visibility. In this study, the effectiveness of premedication with pronase for improving visibility during endoscopy was investigated.

Methods

From April 2010 to February 2011, 400 outpatients were randomly assigned to receive endoscopy with one of four premedications as follows: dimethylpolysiloxane (DMPS), pronase and sodium bicarbonate with 10 minutes premedication time (group A, n=100), DMPS and sodium bicarbonate with 10 minutes premedication time (group B, n=100), DMPS, pronase and sodium bicarbonate with 20 minutes premedication time (group C, n=100), and DMPS and sodium bicarbonate with 20 minute premedication time (group D, n=100). One endoscopist, who was unaware of the premedication types, calculated the visibility scores (range, 1 to 3) of the antrum, lower gastric body, upper gastric body and fundus. The sum of the scores from the four locations was defined as the total visibility score.

Results

Group C showed significantly lower scores than other groups (p=0.002). Group C also had the lowest frequency of flushing, which was significantly lower than that of group D. Groups C and D had significantly shorter durations of examination than groups A and B.

Conclusions

Using pronase 20 minutes before endoscopy significantly improved endoscopic visualization and decreased the frequency of water flushing.

Citations

Citations to this article as recorded by

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A Clinical Usefulness of Premedication with Hyoscine N-butyl Bromide in Colonoscopy: Eun Ok Kim, M.D., Suck-Ho Lee, M.D., Duk Su Kim, M.D., Chang Kyun Lee, M.D., Tae Hoon Lee, M.D., Il-Kwun Chung, M.D., Sang-Heum Park, M.D. and Sun-Joo Kim, M.D.; Korean J Gastrointest Endosc 2010;41(1):10-15. Published online July 31, 2010

Abstract PDF: Background
/Aims: We conducted a prospective, randomized, double-blinded, placebo-controlled trial to investigate the effect of hyoscine-N-butyl bromide during colonoscopy.
Methods
A total of 133 patients undergoing colonoscopy were randomized to receive either 20 mg of hyoscine-N-butyl bromide (n=70) or normal saline solution (n=63) via intramuscular injection as premedication.
Results
The mean cecal intubation time and withdrawal time in the hyoscine- N-butyl bromide group were significantly shorter than those of the control group (5.26±2.78 min vs. 6.74±4.89 min; p=0.032, 5.42±1.54 min vs. 6.18±2.54 min; p=0.038, each). The spasm grade in the hyoscine-N-butyl bromide group was significantly lower than that of the control group (p＜0.001). No significant differences were found in the polyp detection rate (15.7% vs. 28.6%; p=0.073) and adenoma detection rate (10.0% vs. 15.9%; p=0.311). Difficulty of colonoscopy for the endoscopists and nurses (p=0.853; p=0.732), the patient's comfort (p=0.891) and the patient's willingness to repeat colonoscopy (85.7% vs. 82.5%; p=0.932) were also similar in both groups.
Conclusions
Premedication with intramuscularly administered hyoscine-N-butyl bromide do not demonstrate any additional benefits except reducing the colonoscopy insertion time. (Korean J Gastrointest Endosc 2010;41:10-15)

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The Efficacy of Cimetropium Bromide as a Premedication before Esophagogastroduodenoscopy: Jue Yong Lee, M.D., Sung Jung Kim, M.D., Chang Soon Choi, M.D., Young Mook Kim, M.D., Hyun Joo Jeong, M.D., Jung Eun Lee, M.D., Gwang Ho Baik, M.D., Jin Bong Kim, M.D. and Dong Joon Kim, M.D.; Korean J Gastrointest Endosc 2008;37(6):403-408. Published online December 30, 2008

Abstract PDF: Background/Aims: Cimetropium bromide has been used widely as a premedication for endoscopy; however, there are no subjective data pertaining to the effects of cimetropum bromide as a premedication. Thus, the current study was undertaken to compare the effects of cimetropum bromide with placebo as a premedication for esophagogastroduodenoscopy (EGD). Methods: Two hundred ninety-nine consecutive outpatients who had undergone EGD were enrolled in this study. Thirty minutes before EGD, the patients were randomly given an intramuscular injection of cimetropium bromide (5 mg) or saline using a placebo-controlled, double-blind, randomized technique. Immediately after EGD, all the patients and endoscopists were requested to fill out the questionnaire form. Results: One-hundred patients were injected with cimetropium bromide and 150 patients were injected with placebo. There was no statistically significant difference in the degree of residual gastric secretions, the peristaltic activity detected by endoscopists, and the comfort experienced by the patients in each study group. Conclusions: The intramuscular injection of cimetropium bromide (5 mg) as a premedication for EGD was not significantly superior to placebo, at least with respect to subjective parameters, in spite of its broad use. (Korean J Gastrointest Endosc 2008;37:403-408)

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원저 : 신생아 및 영아 환아에서 상부위장관 내시경검사의 임상적 유용성 ( The Clinical Usefulness of Esophagogastreduodenoscopy in Neonates and Infants ): Korean J Gastrointest Endosc 2000;20(6):425-430. Published online November 30, 1999

Abstract PDF: Background
/Aims: Endoscopic examination of upper gastrointestinal tract disease in infancy and childhood was introduced 2 decades ago. However, clinical indication, premedication, endoscopic features, and practical problems have been infrequently reported in neonate and infants, Therefore, the usef'ulness and problems of endoscopy in these pediatric patients was evaluated. Methods: Twelve pediatric patients who underwent endos-copic examination which involved a choledochoscope, bronchoscope, and gastrofibroscope included 8 neonates and 4 infants who suffered from gastrointestinal symptoms. Drugs for premedication were chloral hydrate, diazepam, midazolam and ketamine in single or combined administration. Results: Clinical manifestations were hematemesis (67%), melena (42%), vomiting (8%), weight loss (8%), fever (8%) and irritability (8%). Indica-tions for endoscopic examination were upper gastrointestinal Weeding (67%), upper gastrointestinal obstruction (8%), acute drug intoxication (8%), foreign bodies in the stomach (8%) and evaluation for varix (8%). Endo-scopic findings revealed a gastric ulcer (48%), acute gastric mucosal lesion (8/<), external compression on the duodenum (8%), a gastric foreign body (8%), acute esophago-gastritis (8%) and esophageal and gastric varix (8%). Therapeutic endoscopy was performed in 2 patients, One case of hypoxia occurred during diagnostic endoscopy. Conclusions: Endoseopic examination of the upper gastrointestinal tract is a useful and safe proce-dure to detect diseases in neonates and infants if it is done by experienced endocopists and in the circumstances of adequate premedication. (Korean J Gastrointes4 Kndwc 200;20:425-430)

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상부 위장관 내시경 검사 시 전처치로서의 Propofol의 효과 ( Propofol as Premedication for Upper Gastrointestinal Endoscopy ): Korean J Gastrointest Endosc 2000;20(3):165-170. Published online November 30, 1999

Abstract PDF: Background
/Aims: Benzodiazepine is generally used when sedation is required for endoscopy, while propofol, a phenol-derived intravenous anesthetic agent, appears to have a more suitable phamacokinetic profile. The aim of this study was to evaluate the effectiveness and safety of propofol as premedication for upper gastrointestinal endoscopy. Methods: Between July 1998 and October 1998, 44 male patients and 70 female patients were involved in this study. The relative ease of upper gastrointestinal endoscopy, patient's tolerance, and amnestic effects on 64 patients with propofol was compared with 50 patients with non-sedation. Pulse rate and arterial oxygen saturation was monitored. The endoscopist and patients replied to a questionnaire. Results: Patients receiving propofol tolerated endoscopy much more than patients with non-sedation (p＜0.01). The change in pulse rate was less variable but arterial oxygen saturation showed a statistically significant decrease in patients receiving propofol (p＜0.01). Propofol induced complete amnesia in 93.7% of the patients and partial anesthesia in 4.7%. Most of the patients receiving propofol accepted the same sedative methods in their next endoscopy (p＜0.01). Conclusions: Propofol is highly effective, with a short recovery time and satisfaction of the patients, but careful monitoring is recommended because of its untoward effect of hypoxia. It is recommended that propofol be used as a premedication especially in patients who are apprehensive about a repeated endoscopy.

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Propofol 지속정주를 이용한 상부소화관 내시경 ( Gastrointestinal Endoscopy under Sedation with a Continuous Infusion of Propofol ): Korean J Gastrointest Endosc 1999;19(5):706-715. Published online November 30, 1998

Abstract PDF: Background
/Aims: Propofol is a short-acting intravenous sedative-hypnotic agent that can be used as a hypnotics for upper gastrointestinal endoscopy. A study was conducted to evaluate the effectiveness and safety of propofol as a hypnotic agent for upper gastrointestinal endoscopy. Methods: From June to October 1998, twenty eight patients undergoing upper gastrointestinal endoscopy were to receive propofol. Vital signs and peripheral oxygen saturation (SpO2) were monitored by pulse oximetry during continuous infusion of propofol. Propofol (1% solution) was initially infused by 26.7 mg/kg/hr until loss of eyelash reflex and then titrated to 6∼10 mg/kg/hr according to the patient's response and vital sign. Propofol infusion was discontinued while the endoscopic fiber was removed. Recovery time was defined from discontinuation of infusion to positive Romberg test. Evaluation was made from the endoscopists' assessment, patients' satisfaction, patients' recall of the procedure, and consciousness of the patients. Results: It was discovered that systolic, diastolic pressure and heart rate were significantly decreased, compared to control group. But clinically significant changes were not found. Apnea did not exist. And the respiration rate was significantly increased during propofol infusion. Peripheral oxygen saturation (SpO2) was transiently decreased during endoscopy. 14 patients (50%) complained of transient dizziness. Pain and redness over the infusion site was not found. The mean total dose of propofol was 133.6 mg. The mean infusion time of propofol was 6.2 minutes. Mean response and recovery time was 3.7 2.1, 20.9 5.4 minutes. Endoscopists' assessment and patients' comfort for endoscopy were satisfactory. When we asked 28 patients about willingness to undergo the same procedure in the future, 27 patients (96.4%) agreed. Degree of amnesia after examination revealed total amnesia in 27 patients (96.4%), partial amnesia in 1 patients (3.6%), and recall was not. Conclusions: Propofol has beneficial effects as hypnotic for upper gastrointestinal endoscopy without significant alteration in cardiopulmonary parameters. Patients' and endoscopists' assessment is good. This suggest that propofol may be used more frequently as a kind of premedication, especially in the cases of repeated endoscopy. (Korean J Gastrointest Endosc 19: 706∼715, 1999)

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원저 : 식도 위장관 ; 대장내시경검사의 전처치로서 항콜린제 사용에 관한 연구 - 전향적 , 이중맹검법으로 - ( Original Articles : Esophagus , Stomach & Intestine ; A Clinical Usefulness of Premedication with Hyoscine-N- butyl bromide ( Buscopanⓡ ) in Colonoscopy - A Randomized , Double Blinded , Prospective Study - ): Korean J Gastrointest Endosc 1997;17(3):346-350. Published online November 30, 1996

Abstract PDF: Background
Use of antispasmodic medication prior to colonoscopy is controversial but someone believes antispasmodic may improve visualization of colonic mucosa and ease colonoscope insertion. So, we designed a study to assess the effect of premedication with the antispasmodic, hyoscine-N-butyl bromide(Buscopan') on the performance of colonoscopy. Methods: This study was prospective, double blinded, randomized, controlled study, One hundred three consecutive patients were randomized to receive intravenous buscopan lml(n=52) or placebo(n=51) combined with our standard initial medication(me- peridine 50 mg and midazolam 2 mg). Insertion of colonoscopy was timed, and 100 mm visual analogue scales (VAS) were used for asscssing difficulty of procedure, colonic motility, frequency of positional change, frequency of external compression, difficulty of assistance and degree of discomfort experienced by the patients. Results: There were no significant differences of intubation time between buscopan group(mean time, 7.23 min., range 2~15) and placebo group(7.07 min., range 3-25), (p=0.83) and withdrawal time between buscopan group (6.46 min., range 2-22) and placebo group(6.76 min., range 2 25), (p=0.69). Also, there was no significant differences in intubation time between males and females(buscopan; males 7.00 min., females 7.60 min., p=0.34, placebo; males 7.0~5 min., females 7.08 min., p 0.44). The VAS scores checked by endoscopist(p=0.29), assistant(p=0.32) and patient (p=0.15) were not significantly different in both groups. There were no significant differences in intubation time, VAS scores nf endoscopist, assistant, and patients. Conclusion: Premedication with intravenous bu.opan has no advantage on colonoscopy procedure. Use of antispasmodic medication prior to colonoscopy was not considered as recommendable agent, (Korean J Gastrointest Kndosc 17: 346-350, 1997)

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원저 : 식도 위장관 ; 상부 위장관 내시경 검사시 전처치로서의 Midazolam 의 효과 ( Original Articles : Esophagus , Stomach & Intestine ; Midazolam as Premedication for Upper Gastrointestinal Endoscopy ): Korean J Gastrointest Endosc 1996;16(2):181-190. Published online November 30, 1995

Abstract PDF: The intravenous administration of midazolam is widely used as sedative premedication for upper gastrointestinal endoscopy. We performed a study to evaluate the effectiveness and safety of midazoiam as premedication for upper gastrointestinal endoscopy. Between June 1995 and October 1995, 112 patients of diagnostic esophago-gastroduodenoseopy were enrolled in the study. The patients were recieved a bolus midazolam 0.~03mg/kg or placebo, followed by typical anesthesia. The blood pressure, pulse and oximeter values were monitored. The systolic blood pressure and heart rate were increased during endoscopy in compared with before premedication, and normalized immediately. There was no significant change of arterial oxygen saturation. Midazolam induced amnesia completely in 49.2% and partially in 27.2%, and all patients were recovered completely in 1 hour. The tolerance score is higher in the midazolam group as compared with the placebo group(p<0.05), and midazolam group would accept the same sedation for repeated endoscopies(p<0.01). We conclude that midazolam has beneficial effects as premedication for upper gastrointastinal endoscopy without significant altteration in cardiopulmonary parameters. This suggest that midazolam may be used more frequently as premedication, especially in the cases of repeated endoscopy. (Korean J Gastrointest Endoec 16: 181-190, 1996)

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