{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T22:04:36Z","timestamp":1780610676310,"version":"3.54.1"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"10","license":[{"start":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T00:00:00Z","timestamp":1697500800000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Sint Antonius Research Fund","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n            Background and study aims Simethicone is useful as premedication for upper endoscopy because of its antifoaming effects. We aimed to evaluate the effect of timing of simethicone administration on mucosal visibility.<\/jats:p><jats:p>\n            Patients and methods In this multicenter, randomized, endoscopist-blinded study, patients scheduled for upper endoscopy were randomized to receive 40 mg simethicone at the following time points prior to the procedure: 20 to 30 minutes (early group), 0 to 10 minutes (late group) or 20 mg simethicone at both time points (split-dose group). Images were taken from nine predefined locations in the esophagus, stomach, and duodenum before endoscopic flushing. Each image was scored on mucosal visibility by three independent endoscopists on a 4-point scale (lower scores indicating better visibility), with adequate mucosal visibility defined as a score \u2264 2. Primary outcome was the percentage of patients with adequate total mucosal visibility (TMV), reached if all median subscores for each location were \u2264 2.<\/jats:p><jats:p>\n            Results A total of 386 patients were included (early group: 132; late group: 128; split-dose group: 126). Percentages of adequate TMV were 55%, 42%, and 61% in the early, late, and split-dose group, respectively (P &lt; 0.01). Adequate TMV was significantly higher in the split-dose group compared to the late group (P &lt; 0.01), but not compared to the early group (P = 0.29). Differences between groups were largest in the stomach, where percentages of adequate mucosal visibility were higher in the early (68% vs 53%, P = 0.03) and split-dose group (69% vs 53%, P = 0.02) compared to the late group.<\/jats:p><jats:p>\n            Conclusions Mucosal visibility can be optimized with early simethicone administration, either as a single administration or in a split-dose regimen.<\/jats:p>","DOI":"10.1055\/a-2157-5034","type":"journal-article","created":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T23:15:31Z","timestamp":1697584531000},"page":"E992-E1000","source":"Crossref","is-referenced-by-count":7,"title":["Optimal timing of simethicone administration prior to upper endoscopy: A multicenter, single-blind, randomized controlled trial"],"prefix":"10.1055","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nl8383","registry":"10.18810\/dutch-trial-register"}],"author":[{"given":"I.N.","family":"Beaufort","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands"},{"name":"Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.E.","family":"Verbeek","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.H.","family":"Bosman","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9655-6841","authenticated-orcid":false,"given":"A.","family":"Al-Toma","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Bogte","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Alvarez Herrero","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.L.A.M.","family":"Weusten","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands"},{"name":"Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,10,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"5628","DOI":"10.3390\/cancers13225628","article-title":"Gastric cancers missed at upper endoscopy in central Norway 2007 to 2016 \u2013 a\n          population-based study","volume":"13","author":"M Beck","year":"2021","journal-title":"Cancers (Basel)"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1055\/a-1675-4136","article-title":"Prevalence and risk factors of upper gastrointestinal cancers missed during endoscopy: A nationwide registry-based study","volume":"54","author":"W Januszewicz","year":"2022","journal-title":"Endoscopy"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1097\/MEG.0000000000000657","article-title":"Missing rate for gastric cancer during upper gastrointestinal endoscopy: A systematic review and meta-analysis","volume":"28","author":"AR Pimenta-Melo","year":"2016","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1177\/2050640618811477","article-title":"Rate of missed oesophageal cancer at routine endoscopy and survival outcomes: A multicentric cohort study","volume":"7","author":"E Rodr\u00edguez de Santiago","year":"2019","journal-title":"United European Gastroenterol J"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1177\/2050640617737466","article-title":"\u2018Missed\u2019 oesophageal adenocarcinoma and high-grade dysplasia in Barrett\u2019s oesophagus patients: A large population-based 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Endosc"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s13063-021-05527-8","article-title":"Simethicone administration improves gastric cleanness for esophagogastroduodenoscopy: a randomized clinical trial","volume":"22","author":"X Sun","year":"2021","journal-title":"Trials"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/MCG.0b013e3182758944","article-title":"Determination of the optimal time for premedication with pronase, dimethylpolysiloxane, and sodium bicarbonate for upper gastrointestinal endoscopy","volume":"47","author":"JG Woo","year":"2013","journal-title":"J Clin Gastroenterol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1055\/a-1865-4180","article-title":"The Toronto Upper Gastrointestinal Cleaning Score: a prospective validation study","volume":"55","author":"R Khan","year":"2023","journal-title":"Endoscopy"}],"container-title":["Endoscopy International 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