Li Yuanfa, Du Fangjuan, Fu Dou
Department of Gastroenterology, Xiantao First People's Hospital, China.
Department of Gastroenterology, Liaocheng Second People's Hospital, China.
Saudi J Gastroenterol. 2019 Jul-Aug;25(4):218-228. doi: 10.4103/sjg.SJG_538_18.
BACKGROUND/AIM: To assess the efficacy and safety of simethicone with or without N-acetylcysteine (NAC) as premedications before gastroscopy.
We searched EMBASE, PubMed, Cochrane library and Web of Science database for randomized clinical controlled trials regarding simethicone ± NAC as oral drinking agents before gastroscopy. Statistical software RevMan5.3 was used for statistical analysis.
Ten randomized clinical trials that fulfilled the inclusion criteria were further pooled into a meta-analysis, which included 5,750 patients. The rate of positive findings in simethicone plus NAC group was higher than that in water group (risk ratio [RR] =1.31, 95%CI: 1.12-1.53, P = 0.0006) with high level of evidence. There was no significant difference on the rate of positive findings when comparing simethicone with simethicone plus NAC (RR = 1.02, 95%CI: 0.90-1.16, P = 0.71) and with water (RR = 1.13, 95%CI: 0.82-1.55, P = 0.46), respectively. Simethicone plus NAC showed better total mucosal visibility score than simethicone alone (MD = -0.14 (-0.25, -0.03), P = 0.01) without obvious heterogeneity. Both simethicone plus NAC and simethicone alone offer more benefit than water. The procedure time in simethicone group was shorter than that in water group (MD = -1.23 (-1.51, -0.96), P < 0.00001). Regarding adverse events, there was no significant difference in simethicone and water group (RR = 0.45, 95%CI: 0.2-1.0, P = 0.05, I = 0%).
As premedication of gastroscopy, simethicone plus NAC offers more benefit on positive findings and total mucosal visibility score.
背景/目的：评估西甲硅油单独或联合N-乙酰半胱氨酸（NAC）作为胃镜检查前预处理药物的有效性和安全性。
我们检索了EMBASE、PubMed、Cochrane图书馆和科学网数据库，以查找关于西甲硅油±NAC作为胃镜检查前口服饮品的随机临床对照试验。使用统计软件RevMan5.3进行统计分析。
10项符合纳入标准的随机临床试验被进一步纳入荟萃分析，共纳入5750例患者。西甲硅油联合NAC组的阳性发现率高于水组（风险比[RR]=1.31，95%CI：1.12-1.53，P=0.0006），证据等级高。比较西甲硅油与西甲硅油联合NAC（RR=1.02，95%CI：0.90-1.16，P=0.71）以及西甲硅油与水（RR=1.13，95%CI：0.82-1.55，P=0.46）时，阳性发现率无显著差异。西甲硅油联合NAC的总黏膜可见度评分优于单独使用西甲硅油（MD=-0.14（-0.25，-0.03），P=0.01），且无明显异质性。西甲硅油联合NAC和单独使用西甲硅油均比水更有益。西甲硅油组的操作时间短于水组（MD=-1.23（-1.51，-0.96），P<0.00001）。关于不良事件，西甲硅油组和水组无显著差异（RR=0.45，95%CI：0.2-1.0，P=0.05，I²=0%）。
作为胃镜检查的预处理药物，西甲硅油联合NAC在阳性发现和总黏膜可见度评分方面更有益。
