Efforts to increase image quality during endoscopy: The role of pronase

Table 1 Summary of studies about premedication with pronase for visualization of the mucosa during conventional endoscopy

Ref.	Year	Study design	Premedication group (n)	Mucosal visibility
Fujii et al[8]	1998	Prospective	A: DMPS (34) B: DMPS + SB (32) C: DMPS + SB + pronase (34)	C > A, B
Kuo et al[6]	2002	Prospective	A: DMPS (34) B: DMPS + water (30) C: Pronase + water (31) D: Pronase + SB + water (32) E: Pronase + SB + DMPS + water (33)	E > A, B, C, D
Chang et al[12]	2007	Prospective	A: DMPS (39) B: DMPS + water (35) C: Pronase + SB + DMPS + water (34) D: N-acetylcystein + DMPS + water (39)	C = D > A, B
Bhandari et al[30]	2010	Prospective	A: Drinking of simethicone + pronase + water (35) B: Endoscopic flushing of simethicone + water (37) C: Endoscopic flushing of simethicone + pronase + water (40)	A > B, C
Lee et al[13]	2012	Prospective	A: DMPS + SB + pronase within 10 min (100) B: DMPS + SB within 10 min (100) C: DMPS + SB + pronase within 20 min (100) D: DMPS + SB within 20 min (100)	A = C > B, D
Woo et al[26]	2013	Prospective	A: Pronase + SB + DMPS within 10 min (98) B: Pronase + SB + DMPS between 10-30 min (97) C: Pronase + SB + DMPS at 30 min (99)	A = B > C
Kim et al[7]	2015	Prospective	A: Simethicone + SB + pronase (71) B: Simethicone (72)	A > B

DMPS: Dimethylpolysiloxane; SB: Sodium bicarbonate.

Table 2 Summary of studies about premedication with pronase for visualization of the mucosa during advanced endoscopy

Examination	Ref.	Year	Study design	Premedication group (n)	Mucosal visibility
Chromoendoscopy	Fujii et al[8]	1998	Prospective	A: DMPS (34) B: DMPS + SB (32) C: DMPS + SB + pronase (34)	C > A, B
NBI endoscopy	Cha et al[17]	2014	Prospective	A: Pronase + SB (28) B: Simethicone (27)	A > B
ME-NBI	Kim et al[7]	2015	Prospective	A: Simethicone + SB + pronase (71) B: Simethicone (72)	A > B
EUS	Sakai et al[24]	2003	Prospective	A: DMPS (29) B: DMPS + SB (29) C: DMPS + SB + pronase (29)	C > A, B
	Han et al[25]	2011	Prospective	A: Saline (60) B: Pronase + SB (62) C: Pronase + SB + simethicone (61)	B > A > C

NBI: Narrow-band imaging; ME-NBI: Magnifying endoscopy with narrow-band imaging; EUS: Endoscopic ultrasonography; DMPS: Dimethylpolysiloxane; SB: Sodium bicarbonate.