The combination of simethicone and N-acetylcysteine in lidocaine ice popsicle compared with lidocaine ice popsicle alone in patients undergoing unsedated esophagogastroduodenoscopy: A prospective double-blind randomized controlled trial.
Pailin Intarasangkhanawin, Saritphat Orrapin, Worapong Anuponganan et al.
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In 30 seconds
This single-centre, prospective, double-blind randomised controlled trial compared a lidocaine ice popsicle containing simethicone and N-acetylcysteine (NAC) with a conventional lidocaine popsicle in 374 adults undergoing unsedated diagnostic esophagogastroduodenoscopy. The combination group had better mucosal visibility, with a lower modified Total Visibility Score than controls (6.19 ± 0.51 vs. 10.39 ± 2.22; mean difference, -4.20; 95% CI, -4.53 to -3.88; P < 0.001). Procedure time was also shorter, and additional diluted simethicone was used less often. Patient satisfaction and discomfort did not differ significantly; no adverse events were observed during the defined observation period.
Key findings
- Modified Total Visibility Score was lower with simethicone and NAC than with lidocaine alone (6.19 ± 0.51 vs. 10.39 ± 2.22; mean difference, -4.20; 95% CI, -4.53 to -3.88; P < 0.001).
- Mean procedure time was 10.87 ± 1.44 vs. 12.75 ± 0.96 min (P < 0.001) in the combination and control groups, respectively.
- Additional diluted simethicone was used in 12.8% vs. 96.8% of participants (P < 0.001), respectively.
- Patient satisfaction, discomfort, and ease of esophageal instrumentation did not differ significantly; no adverse events were observed during the defined observation period.
Why it matters
Clear mucosal views support the examination of subtle upper gastrointestinal lesions. This trial suggests that combining mucosal-cleansing agents with topical anesthesia may improve visibility and procedural efficiency during unsedated diagnostic EGD, without a detected difference in patient satisfaction or discomfort. The findings are relevant to endoscopic preparation, but confirmation across centres and with longer safety follow-up is needed.
What to keep in mind
The trial was conducted at a single centre, and the authors call for multicentre studies and longer follow-up to confirm generalisability and safety.