Is premedication with pronase advisable to patients undergoing endoscopy?

Prior to upper gastrointestinal endoscopy, premedication with pronase helps achieve better mucosal visibility and reduce flushing frequency and volume, reports a study. However, this strategy does not appear to improve lesion detection rates.

In this study, the authors confirmed “whether premedication with pronase before endoscopy improves mucosal visualization and increases precancerous lesion and cancer lesion detection rates.”

Outpatients scheduled for endoscopy across 13 hospitals between June 2018 and April 2019 were screened and subsequently randomized 2:1 to premedication with either pronase (group A) or water (group B). Mucosal visibility scores were the primary endpoint. Secondary endpoints included precancerous and cancer lesion detection rates.

Patients in group A achieved significantly lower mucosal visibility scores (which meant better mucosal visibility) of the esophagus, stomach, and duodenum than did those in group B (p<0.001 for all).

Overall, the detection rates did not significantly differ between groups A and B (0.83 percent vs 1.08 percent). Overall detection rates of precancerous and cancer lesion were also comparable (4.4 percent vs 4.9 percent) between the two arms (p=1.000 and p=0.824).

On the other hand, group A achieved lesser flushing volume (10.52 vs 36.30 mm; p<0.001) as well as flushing frequency (0.46 vs 1.62; p<0.001) compared with group B.

“Premedication with pronase could achieve better mucosal visibility and decrease flushing frequency and volume, but may not increase lesion detection rates,” the authors said.