{
    "abstract": "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.\nWe 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.\nThis 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.\nThe administration of simethicone with or without NAC may improve EGD quality.",
    "authors": [
        {
            "affiliation": "School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia (Caroline Tanadi, Fegita Beatrix Pajala, Maureen Miracle Stella).",
            "firstname": "Caroline",
            "initials": "C",
            "lastname": "Tanadi"
        },
        {
            "affiliation": "School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia (Caroline Tanadi, Fegita Beatrix Pajala, Maureen Miracle Stella).",
            "firstname": "Fegita Beatrix",
            "initials": "FB",
            "lastname": "Pajala"
        },
        {
            "affiliation": "Bioinformatics Research Center, Indonesian Institute of Bioinformatics (INBIO-INDONESIA), Malang (Yehuda Tri Nugroho Supranoto).",
            "firstname": "Yehuda Tri Nugroho",
            "initials": "YTN",
            "lastname": "Supranoto"
        },
        {
            "affiliation": "Intensive Care Unit, Columbia Asia Hospital, Semarang (Kevin Tandarto).",
            "firstname": "Kevin",
            "initials": "K",
            "lastname": "Tandarto"
        },
        {
            "affiliation": "School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia (Caroline Tanadi, Fegita Beatrix Pajala, Maureen Miracle Stella).",
            "firstname": "Maureen Miracle",
            "initials": "MM",
            "lastname": "Stella"
        },
        {
            "affiliation": "Gastrointestinal Cancer Center, MRCCC Siloam Hospital Semanggi, Jakarta (Randy Adiwinata Paulus Simadibrata).",
            "firstname": "Randy",
            "initials": "R",
            "lastname": "Adiwinata"
        },
        {
            "affiliation": "Gastrointestinal Cancer Center, MRCCC Siloam Hospital Semanggi, Jakarta (Randy Adiwinata Paulus Simadibrata).",
            "firstname": "Paulus",
            "initials": "P",
            "lastname": "Simadibrata"
        },
        {
            "affiliation": "Division of Gastroenterology, Pancreatobiliary and Digestive Endoscopy, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta (Marcellus Simadibrata), Indonesia.",
            "firstname": "Marcellus",
            "initials": "M",
            "lastname": "Simadibrata"
        }
    ],
    "conclusions": "The administration of simethicone with or without NAC may improve EGD quality.",
    "copyrights": "Copyright: \u00a9 2025 Hellenic Society of Gastroenterology.",
    "doi": "10.20524/aog.2024.0930",
    "journal": "Annals of gastroenterology",
    "keywords": [
        "N-acetylcysteine",
        "Simethicone",
        "esophagogastroduodenoscopy",
        "meta-analysis",
        "premedication"
    ],
    "methods": null,
    "publication_date": "2025-01-13",
    "pubmed_id": "39802290\n22624807\n26260369\n8083482\n2468589\n28529184\n1612040\n17230616\n20718163\n21826120\n22072853\n24325147\n23739279\n27853746\n27852098\n27867691\n29037773\n29572630\n32016519\n32063954\n33532557\n34158672\n36262507\n35571469\n37581331\n37115977\n25436356\n29971260\n31044749",
    "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.",
    "title": "Simethicone with or without N-acetylcysteine as premedication in esophagogastroduodenoscopy: a systematic review and meta-analysis.",
    "xml": "<Element 'PubmedArticle' at 0x788503a1ee80>"
}