Determination of the optimal time for premedication with pronase, dimethylpolysiloxane, and sodium bicarbonate for upper gastrointestinal endoscopy.

GOALS AND BACKGROUND: Premedication with pronase, dimethylpolysiloxane, and sodium bicarbonate improves visibility during upper gastrointestinal (UGI) endoscopy. However, the optimal time for this combination to take effect is unknown. We investigated the optimal time of pre-UGI endoscopy medication. STUDY: A randomized, investigator-blind, controlled trial. The 300 patients who were to receive premedication were randomized into 3 groups according to the following medication time before UGI endoscopy: 10 minutes (group A, n=98), 10 to 30 minutes (group B, n=97), and 30 minutes premedication (group C, n=99). Visibility scores (range, 1 to 4, with lower scores indicating better gastric mucosal visibility) were assessed for the antrum, lower body, upper body, and fundus and compared, including the sum of the scores, between the 3 groups. RESULTS: Group B had significantly lower visibility scores for the lower body, upper body, and fundus than group C (P=0.001, 0.009, and 0.002, respectively). Group A obtained significantly lower scores for the antrum and lower body than group C (P=0.007 and 0.005, respectively). The total visibility scores of groups A and B were significantly lower compared with those of group C (P=0.001, 0.003, respectively). CONCLUSIONS: Administration of pronase, dimethylpolysiloxane, and sodium bicarbonate within 30 minutes before UGI endoscopy significantly improved endoscopic visualization. However, the optimal time to achieve the best visibility was between 10 to 30 minutes before UGI endoscopy.

The efficacy and safety of carbon dioxide insufflation during colonoscopy with consecutive esophagogastroduodenoscopy in moderately sedated outpatients: a randomized, double-blind, controlled trial.

GOALS AND BACKGROUND: Colonoscopy with consecutive esophagogastroduodenoscopy (CCEGD) can be more convenient than performing each procedure individually. There has been no randomized controlled trial comparing carbon dioxide (CO2) versus air insufflations during CCEGD in sedated patients. CO2 insufflation instead of air during CCEGD may reduce abdominal pain and be more comfortable. We investigated the efficacy and safety of CO2 insufflation during CCEGD in moderately sedated outpatients. STUDY: This was a randomized, double-blind, controlled trial. A total of 96 outpatients were randomly assigned to the groups of CO2 or air insufflation. Postprocedure pain was assessed using a 0 to 10 visual analogue scale, and the proportion of pain-free patients was compared between the groups. Waist circumferences and end-tidal CO2 (ETCO2) were measured. RESULTS: Among 96 patients, cecal intubation failed in 2 patients, who were excluded from the analysis. Forty-eight patients in the CO2 and 46 patients in the air group completed the study. There was significant difference between the 2 groups regarding the proportion of pain-free patients 30 minutes after the procedures [air group, 35/46 (76.1%) vs. CO2 group, 44/48 (91.6%)] (P=0.03). However, there was no significant difference in the proportion at 6 and 24 hours after the procedures. The mean increase in waist circumference was greater with air than with CO2 (1.54 vs. 0.18 cm, P<0.001). The ETCO2 measured immediately after the procedures was slightly higher in the CO2 group than in the air group (38.6 vs. 37.2 mm Hg, P=0.02), but the values were within the normal range. No significant adverse events occurred. CONCLUSIONS: CO2 insufflation during CCEGD reduced postprocedural pain and distension compared with air. It was comfortable and safe to use in moderately sedated outpatients.

Efficacy of prokinetics with a split-dose of polyethylene glycol in bowel preparation for morning colonoscopy: a randomized controlled trial.

BACKGROUND/AIMS: Currently, a split-dose of polyethylene glycol (PEG) is the mainstay of bowel preparation due to its tolerability, bowel-cleansing action, and safety. However, bowel preparation with PEG is suboptimal because residual fluid reduces the polyp detection rate and requires a more thorough colon inspection. The aim of our study was to demonstrate the efficacy of a sufficient dose of prokinetics on bowel cleansing together with split-dose PEG. METHODS: A prospective endoscopist-blinded study was conducted. Patients were randomly allocated to two groups: prokinetic with split-dose PEG or split-dose PEG alone. A prokinetic [100 mg itopride (Itomed)], was administered twice simultaneously with each split-dose of PEG. Bowel-cleansing efficacy was measured by endoscopists using the Ottawa scale and the segmental fluidity scale score. Each participant completed a bowel preparation survey. Mean scores from the Ottawa scale, segmental fluid scale, and rate of poor preparation were compared between both groups. RESULTS: Patients in the prokinetics with split-dose PEG group showed significantly lower total Ottawa and segmental fluid scores compared with patients in the split-dose of PEG alone group. CONCLUSION: A sufficient dose of prokinetics with a split-dose of PEG showed efficacy in bowel cleansing for morning colonoscopy, largely due to the reduction in colonic fluid.