Fujii T, Iishi H, Tatsuta M, Hirasawa R, Uedo N, Hifumi K, Omori M
Department of Nursing, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
Gastrointest Endosc. 1998 May;47(5):382-7. doi: 10.1016/s0016-5107(98)70223-8.
Minute early gastric cancers can be removed with endoscopic mucosal resection techniques. However, early detection of these minute cancers with endoscopy is still difficult. For this purpose, use of a dye is helpful. To increase visibility further, gastric mucus should be removed before endoscopic examination. In this study, the effectiveness of premedication with pronase for improving visibility during gastroendoscopy was investigated.
From January through July 1996, outpatients scheduled for gastroendoscopy were randomly assigned to oral premedication with the antifoam agent dimethylpolysiloxane alone (n=34), with dimethylpolysiloxane plus sodium bicarbonate (n=32), or with dimethylpolysiloxane, sodium bicarbonate, and pronase (n=34). All were given about 10 minutes before the start of endoscopy. After inserting the endoscope, the endoscopist gave visibility scores at conventional endoscopy and after methylene blue spraying.
Premedication with pronase significantly improved visibility before and after methylene blue spraying as compared with the two other groups pretreated without pronase. Pronase also significantly shortened the times for chromoendoscopic examination. Pronase had no significant effect on the culture of Helicobacter pylori.
Premedication with pronase improved endoscopic visualization during conventional endoscopy and chromoendoscopy. Its routine use at gastroendoscopy is therefore recommended.
微小早期胃癌可通过内镜黏膜切除术切除。然而，通过内镜早期检测这些微小癌仍很困难。为此，使用染料会有所帮助。为进一步提高可视性，在内镜检查前应清除胃黏液。在本研究中，调查了用链霉蛋白酶进行预处理对提高胃镜检查时可视性的有效性。
1996年1月至7月，计划进行胃镜检查的门诊患者被随机分配为单独口服抗泡沫剂二甲基聚硅氧烷进行预处理（n = 34）、口服二甲基聚硅氧烷加碳酸氢钠进行预处理（n = 32）或口服二甲基聚硅氧烷、碳酸氢钠和链霉蛋白酶进行预处理（n = 34）。均在内镜检查开始前约10分钟给药。插入内镜后，内镜医师在常规内镜检查时以及喷洒亚甲蓝后给出可视性评分。
与未用链霉蛋白酶预处理的其他两组相比，用链霉蛋白酶预处理显著提高了喷洒亚甲蓝前后的可视性。链霉蛋白酶还显著缩短了色素内镜检查的时间。链霉蛋白酶对幽门螺杆菌培养无显著影响。
用链霉蛋白酶预处理可改善常规内镜检查和色素内镜检查时的内镜视野。因此，建议在胃镜检查中常规使用。
