IDDF2019-ABS-0311 Efficacy and cost-effectiveness of premedication with N-acetylcysteine during upper gastrointestinal endoscopy examination: a single center, prospective, single blinded, randomized controlled trial

Background Detecting gastric cancer in the early stage is the key factor in reducing cancer mortality. Endoscopists can now detect early cancer with the aid of advanced imaging in endoscopy. A major technical obstacle in achieving a good quality of endoscopic examination of the gastric mucosa is the presence of foam and mucus over the mucosal surface. Pronase has become a common anti-mucus agent used for improving visibility during upper gastrointestinal endoscopy examination, especially in eastern Asia. While N-acetylcysteine (NAC) can serve as an alternative mucolytic agent more economically. The aim of this study is to investigate the efficacy and cost-benefit of premedication with NAC during esophagogastroduodenoscopy (EGD). Methods We enrolled 1,200 patients and randomly allocated them into 4 groups with different types of premedication. Premedication used in regular group (RG) was 10 mL lidocaine hydrochloride mucilage (LHM) and in pronase+simethicone group (P+S) was 60 mL pronase/simethicone solution plus 10 mL LHM. Meanwhile, 60 mL NAC600 mg/simethicone solution plus 10 mL LHM and 60 mL NAC1200 mg/simethicone solution plus 10 mL LHM were given to the patients in NAC600+simethicone group (NAC600+S) and NAC1200+simethicone group (NAC1200+S), respectively. We recorded visibility scores, times of cleaning, time taken for examination, diminutive lesions and pathological diagnosis. Cost-benefit of premedication was analyzed. Results The visibility of NAC600+S and NAC1200+S are significantly better than RG, although P+S exhibited the lowest total visibility score and shortest procedure duration (figure 1). Times of cleaning was remarkably decreased in NAC600+S and NAC1200+S compared to RG, but was inferior to P+S. There is no significant difference in detection rate of diminutive lesions and pathological diagnosis. Cost-benefit analysis has shown that net medical yield of NAC/simethicone is higher than that of pronase/simethicone. Conclusions NAC can not only facilitate the visibility during EGD, but be more cost-beneficial. It should be recommended as a good alternative premedication to pronase during EGD, especially in developing countries and regions.