在食管胃十二指肠镜检查中使用西甲硅油（含或不含N-乙酰半胱氨酸）作为术前用药：一项系统评价和荟萃分析。
Simethicone with or without N-acetylcysteine as premedication in esophagogastroduodenoscopy: a systematic review and meta-analysis.
作者信息
Tanadi Caroline, Pajala Fegita Beatrix, Supranoto Yehuda Tri Nugroho, Tandarto Kevin, Stella Maureen Miracle, Adiwinata Randy, Simadibrata Paulus, Simadibrata Marcellus
机构信息
School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia (Caroline Tanadi, Fegita Beatrix Pajala, Maureen Miracle Stella).
Bioinformatics Research Center, Indonesian Institute of Bioinformatics (INBIO-INDONESIA), Malang (Yehuda Tri Nugroho Supranoto).
出版信息
Ann Gastroenterol. 2025 Jan-Feb;38(1):28-40. doi: 10.20524/aog.2024.0930. Epub 2024 Dec 12.
BACKGROUND
The impairment of gastrointestinal mucosa visibility during esophagogastroduodenoscopy (EGD), due to the presence of foam and bubbles, may lead to reduced quality in the EGD results. The combination of simethicone, a defoaming agent, along with N-acetylcysteine (NAC), which has mucolytic properties, has been proposed to improve the visibility of the mucosa. This study aimed to evaluate the effectiveness of pre-procedural administration of simethicone and N-acetylcysteine in improving mucosal visibility, procedure time and mucosal cleansing volume needed during EGD.
METHODS
We conducted a comprehensive literature search from inception to November 23, 2023, in PubMed, CENTRAL, ProQuest, SAGE, and JSTOR. We included randomized clinical trials that investigated the effects of simethicone with or without NAC as premedication in EGD. For the quantitative analysis, standardized mean difference (SMD) was used to assess continuous outcomes and risk ratio for dichotomous outcomes. The Cochrane risk of bias 2 tool was used to evaluate the risk of bias.
RESULTS
This meta-analysis comprised a total of 20 studies and found that simethicone with or without NAC improved mucosal visibility compared with control (SMD -1.27, 95% confidence interval [CI] -1.74 to -0.81, P<0.001). The combination of simethicone and NAC was significantly better than simethicone alone (SMD -0.68, 95%CI -1.08 to -0.28, P=0.001). Simethicone with or without NAC also shortened the procedure time compared to control (MD -1.40, 95%CI -2.67 to -0.12, P=0.03). The risk of bias was low with a moderate grade of certainty.
CONCLUSION
The administration of simethicone with or without NAC may improve EGD quality.
背景
由于存在泡沫，食管胃十二指肠镜检查（EGD）期间胃肠道黏膜的可视性受损，这可能导致EGD检查结果质量下降。已有人提出将消泡剂西甲硅油与具有黏液溶解特性的N-乙酰半胱氨酸（NAC）联合使用，以提高黏膜的可视性。本研究旨在评估术前给予西甲硅油和N-乙酰半胱氨酸在改善EGD期间黏膜可视性、检查时间和所需黏膜清洁量方面的有效性。
方法
我们从数据库建库至2023年11月23日在PubMed、CENTRAL、ProQuest、SAGE和JSTOR中进行了全面的文献检索。我们纳入了调查西甲硅油联合或不联合NAC作为EGD术前用药效果的随机临床试验。对于定量分析，使用标准化均数差（SMD）评估连续变量结局，使用风险比评估二分变量结局。采用Cochrane偏倚风险2工具评估偏倚风险。
结果
这项荟萃分析共纳入20项研究，发现西甲硅油联合或不联合NAC与对照组相比，可提高黏膜可视性（SMD -1.27，95%置信区间[CI] -1.74至-0.81，P<0.001）。西甲硅油和NAC联合使用明显优于单独使用西甲硅油（SMD -0.68，95%CI -1.08至-0.28，P=0.001）。与对照组相比，西甲硅油联合或不联合NAC也缩短了检查时间（MD -1.40，95%CI -2.67至-0.12，P=0.03）。偏倚风险较低，确定性为中等等级。
结论
给予西甲硅油联合或不联合NAC可能会提高EGD检查质量。
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