Page 139 - Ebook-Book JCMS 2025

The Combination of Simethicone, N-acetylcysteine and
Lidocaine in Ice Popsicle Compared with Lidocaine Ice
Popsicle Alone in Patients Undergoing Unsedated
Esophagogastroduodenoscopy, A Prospective Double-blind
Randomized Controlled Trial
Pailin Intarasangkhanawin*, Prasit Mahawongkajit
Department of Surgery, Faculty of Medicine, Thammasat University
*Corresponding Author E-mail: pailinin@tu.ac.th
Background: Objective: Methods: Results: Abstract
Background: Esophagogastroduodenoscopy (EGD) is an essential procedure for diagnosing
upper gastrointestinal diseases, early detection significantly improving treatment outcomes.
The use of simethicone and N-acetylcysteine (NAC) has been shown to improve the
visibility of the gastrointestinal lining. Topical anesthesia remains a common choice due to
its proven safety and effectiveness.
This study aimed to compare the visibility of lidocaine ice popsicles combined with
simethicone and NAC and lidocaine ice popsicles alone in patients undergoing unsedated
EGD.
The study was designed as a single-center, prospective, double-blind randomized
controlled trial. Patients were randomly assigned into two treatment groups: Group A
received a lidocaine ice popsicle along with pre-medication agents (simethicone and 600
mg of NAC), while group B received only the lidocaine ice popsicle. Participants were
instructed to allow the ice popsicle to dissolve for 15 minutes prior to the EGD. The Total
Visibility Score (TVS) was evaluated across six segments of upper gastrointestinal tract,
with scores below 7 representing adequate visibility (AV).
384 patients were enrolled, 64% were male, with a mean age of 48.5 years. The most
common indication for EGD was cancer screening (70%). The primary outcome, TVS,
demonstrated a statistically significant difference between two groups (p < 0.01). Group A
achieved a better TVS (6.2 ± 0.4) than group B (10.4 ± 2.2). Group A required significantly
less water for improved visibility (0 ml vs. 150 ml, P < 0.01) and had a shorter procedure
duration (10.8 ± 1.4 minutes vs. 12.8 ± 1.0 minutes, P < 0.001).
Conclusions: Clinical Trial Register: The use of lidocaine ice popsicles combined with simethicone and NAC is an effective
strategy for enhancing visibility during diagnostic EGD, contributing to improved outcomes
in various aspects of the procedure.
Thai Clinical Trials Registry (TCTR) number 20240606004.
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