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| Study ID | Methods | Participants | Interventions | Outcome measure | Anatomical site assessed | Timing of premedication | Result |
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| Kuo et al. [8] | Double blinded randomized trial | 160 patients randomized,
F (92) M (68) mean age 50 | 5 intervention groups: (100 mg DMPS), (100 mg DMPS + 100 ml water), (2000 units of pronase + 100 ml water), (2000 units pronase + 1.2 g sodium bicarbonate + water 100 ml), (2000U pronase + 1.2 g sodium bicarbonate + 100 mg DMPS + 100 ml water)
0 control group | 1 to 4-point scale | (4) gastric antrum, upper body, lower body, fundus | 10 mins | No adverse effects reported.
Premedication with pronase and DMPS in 100 ml water provides optimal visibility in upper gastrointestinal endoscopy. |
| Chang et al. [19] | An endoscopist-blinded, prospective, randomized study | 147 randomized, F (77) M (70) mean age 46 | 4 intervention groups: (100 mg DMPS), (100 mg DMPS + 100 ml water), (20,000 IU pronase + 1.2 g Sodium bicarbonate + 100 mg DMPS + 100 ml water), (400 mg NAC + 100 mg DMPS + 100 ml water)
0 control group | 1 to 4-point scale | (4) gastric antrum, upper body, lower body, fundus | 20 mins | No adverse effects reported.
Premedication with 20000
U pronase, 1.2 g of sodium bicarbonate, 100 mg of DMPS plus up to 100 mL of warm water provided best TMVS |
| Keeratichananont et al. [21] | Double blind, randomized, placebo controlled | 121 randomized,
F (66) M (55) mean age 57 | 1 intervention group: (133 mg sim + 60 ml water)
1 control group (60 ml water) | 1 to 4-point scale | (6) oesophagus, gastric fundus, body, antrum, incisura, duodenum | 15–30 mins | No adverse effects reported.
Simethicone solution was more effective than placebo in reducing obscuring foam and bubbles at all areas of upper gastrointestinal tract. |
| Asl et al. [18] | Double blind, randomized, placebo controlled study | 148 randomized,
F (71) M (77) mean age 42 | 3 intervention groups: (100 mg DMPS + 100 ml water), (600 mg NAC+ 100 ml water), (100 mg DMPS + 600 mg NAC + 100 ml water)1 control group: (100 ml water) | 1 to 4-point scale | (4) gastric antrum, upper body, lower body, fundus | 20 mins | No adverse effects reported.
100 mg activated dimethicone in water up to 100 mL provided superior TMVS |
| Cha et al. [20] | Double blind randomized controlled trial | 55 patients randomized,
F (33) M (22) mean age 55 | 2 intervention groups: (20,000U pronase + 1g sodium bicarbonate + water), (80 mg sim) | 1 to 3-point scale | (4) gastric antrum, upper body, lower body, fundus | 10 mins | No adverse effects reported.
Pronase solution provided a superior TMVS compared to simethicone. |
| Chang et al. [17] | Randomized, investigator-blinded study | 1849 randomized,
F (864) M (985) mean age 54 | 3 intervention groups: (5 ml water + 100 mg sim), (100 ml water + 100 mg sim), (100 ML water + 100 mg sim + 200 mg NAC)
0 control group | 1 to 3-point scale | (7) oesophagus, fundus, upper body, lower body, antrum, duodenal bulb, D2) | 10–30 mins | No adverse effects reported.
100 mg of simethicone improves TMVS, enhanced by addition of NAC |
| Kim et al. [22] | Multicentre, prospective, randomized, double blind study | 143 randomized,
F (56) M (87) mean age 59 | 2 intervention groups: (80 mg sim + 1g sodium bicarbonate + 20,000 U pronase + 100 ml water), (80 mg sim in 20 ml water)
0 control group. | 1 to 4-point scale | (4) gastric antrum, upper body, lower body, fundus | 10 mins | No adverse effects reported.
Pronase + simethicone group provided superior TMVS than simethicone alone. |
| Basford et al. [15] | Randomized controlled clinical trial | 126 randomized,
F (64) M (62) mean age 62 | 2 intervention group: (50 ml water, 1G NAC, 60 mg sim), (50 ml water)
1 control group: (No pre-procedure drink) | 1 to 4-point scale | (4) oesophagus, gastric body, fundus, antrum | 5–10 mins | No adverse effects reported.
Simethicone + NAC premedication significantly improves TMVS. |
| Song et al. [14] | Randomized, placebo controlled, endoscopist- blinded study | 54 randomized,
F (30) M (24) mean age 55 | 1 intervention group (100 mg sim + water)
1 control group: 5 ml water | 1 to 4-point scale | (4) oesophagus, antrum and angularis of the stomach, body and fundus, duodenum | 30 mins | No adverse effects reported.
Simethicone solution provided significantly improved TMVS compared to placebo. |
| Elvas et al. [16] | Single-centre, prospective, double blind, placebo- controlled, randomized trial | 300 randomized,
F (148) M (152) mean age 62 | 2 intervention groups: (100 ml water + 100 mg sim), (100 ml water, 100 mg sim, 600 mg NAC)
1 control group (100 ml water) | Dichotomous: Excellent/Not excellent | (3) oesophagus, stomach body and antrum, duodenum | 15–30 mins | No adverse effects reported.
Simethicone solution improves mucosal visibility, inconclusive effect of addition of NAC. |
| Liu et al. [23] | Randomized, double blind, placebo controlled trial | 7143 randomized,
F (4159) M (2984) mean age 53 | 3 intervention groups: (20,000U pronase + 1g Sodium bicarb + 100 ml water), (80 mg simethicone + 100 ml water), (20,000U pronase + 80 mg simethicone + 1g Sodium bicarbonate + 100 ml water)
1 control group: (100 ml water) | 1 to 3 scale | (5) oesophagus, cardia, fundus, body, antrum | 20 mins | No adverse effects reported.
Simethicone solution was superior to pronase solution in improving TMVS, however the combination was superior still. |
| Monrroy et al. [12] | Parallel assignment, double blinded, placebo- controlled randomized controlled trial | 230 randomized
F (156) M (74) mean age 49 | 4 intervention groups: (50 ml water), (W + Sim200 mg), (W + sim + NAC 500 MG), (W + sim + NAC 1000 MG)
1 control group: No intervention | 1 to 4-point scale | (4) gastric antrum, upper body, lower body, fundus | 20 mins | No adverse effects reported.
Simethicone and NAC solution improves TMVS. |
| Zhang et al. [13] | Prospective, single blinded, randomized controlled trial | 610 randomized,
F (362) M (248) mean age 50 | 1 intervention group: (80 mg sim + 1G sodium bicarbonate + 20,000IU pronase)
1 control group: 10 mL lidocaine hydrochloride mucilage | 1 to 4-point scale | (5) oesophagus, gastric antrum, upper body, lower body, fundus | 20 mins | No adverse effects reported.
Simethicone and pronase solution improved TMVS. |
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