Kim GH, Cho YK, Cha JM, Lee SY, Chung IK. Efforts to increase image quality during endoscopy: The role of pronase. World J Gastrointest Endosc 2016; 8(5): 267-272 [PMID: 26981178 DOI: 10.4253/wjge.v8.i5.267]
Corresponding Author of This Article
Il-Kwun Chung, MD, PhD, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, 23-20 Bongmyung-dong, Dongnam-gu, Cheonan 330-721, South Korea. euschung@schmc.ac.kr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Mar 10, 2016; 8(5): 267-272 Published online Mar 10, 2016. doi: 10.4253/wjge.v8.i5.267
Efforts to increase image quality during endoscopy: The role of pronase
Gwang Ha Kim, Yu Kyung Cho, Jae Myung Cha, Sun-Young Lee, Il-Kwun Chung
Gwang Ha Kim, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 602-739, South Korea
Yu Kyung Cho, Department of Internal Medicine, the Catholic University of Korea, College of Medicine, Seoul 137-701, South Korea
Jae Myung Cha, Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul 134-727, South Korea
Sun-Young Lee, Department of Internal Medicine, Konkuk University School of Medicine, Seoul 143-729, South Korea
Il-Kwun Chung, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan 330-721, South Korea
Author contributions: Kim GH and Chung IK contributed to the review of the literature and initial draft of manuscript; Cho YK, Cha JM and Lee SY contributed to revising and final approval of the manuscript.
Conflict-of-interest statement: All authors declare no conflict-of-interest related to this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Il-Kwun Chung, MD, PhD, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, 23-20 Bongmyung-dong, Dongnam-gu, Cheonan 330-721, South Korea. euschung@schmc.ac.kr
Telephone: +82-41-5703679 Fax: +82-41-5745762
Received: August 22, 2015 Peer-review started: August 26, 2015 First decision: October 30, 2015 Revised: December 1, 2015 Accepted: December 18, 2015 Article in press: December 20, 2015 Published online: March 10, 2016 Processing time: 195 Days and 9.7 Hours
Abstract
Clear visualization of the gastrointestinal mucosal surface is essential for thorough endoscopy. An unobstructed assessment can reduce the need for additional time-consuming manipulations such as frequent washing and suction, which tend to prolong total procedure time. However, mucus, foam, and bubbles often hinder clear visibility during endoscopy. Premedication with pronase, a compound of mixed proteolytic enzymes, has been studied in order to improve mucosal visibility during endoscopy. Although its effects differ according to the location in the stomach, premedication with pronase 10 to 20 min before endoscopy significantly improves mucosal visibility without affecting the accuracy of Helicobacter pylori identification. The effects of pronase as premedication also extend to chromoendoscopy, narrow-band imaging, magnifying endoscopy, and endoscopic ultrasonography. In addition, endoscopic flushing with pronase during endoscopy may improve the quantity and the quality of a biopsy to some degree. Although improved mucosal visibility does not necessarily improve clinical outcomes, premedication with pronase may be helpful for increasing the detection rate of early cancers.
Core tip: The present review discusses the role of pronase in increasing image quality during endoscopy. Premedication with pronase 10 to 20 min before endoscopy significantly improves mucosal visibility without affecting the accuracy of Helicobacter pylori identification. The effects of pronase as premedication are also applicable in advanced endoscopic procedures such as narrow-band imaging, magnifying endoscopy, or endoscopic ultrasonography. Although improved mucosal visibility does not necessarily improve clinical outcomes, premedication with pronase may be helpful for increasing the detection rate of early cancers.
