The edition · Gastroenterology & Hepatology
Adding simethicone and N-acetylcysteine to the lidocaine popsicle sharply improved views at unsedated endoscopy
A double-blind trial of 374 patients found clearer mucosa and shorter procedures. Also: resmetirom works regardless of MASH risk genes, cachexia and surgical complications, and a referral framework for GI cancer.
The edition in brief
A single-centre double-blind trial in Thailand randomised 374 adults having unsedated diagnostic upper endoscopy to a lidocaine ice popsicle containing simethicone 100 mg and N-acetylcysteine 600 mg, or a plain lidocaine popsicle; mucosal visibility scores were markedly better (mean difference −4.2), procedures about two minutes shorter, and extra simethicone flushing was needed in 13% against 97%, with no adverse events. A prespecified analysis of 738 MAESTRO-NASH patients found resmetirom's effects on MASH resolution, fibrosis and liver fat did not differ by PNPLA3, HSD17B13, TM6SF2, MTARC1 or MBOAT7 risk genotypes. A meta-analysis of 34 cohort studies associated cancer cachexia with more postoperative complications (OR 1.38) and two days' longer stay in GI cancer, at very low certainty. A Mexican position statement set out alarm features and urgent, priority and elective referral routes for oesophageal, gastric and colorectal cancer. The pearl covers albumin after large-volume paracentesis.
Resmetirom's effect held across MASH risk genotypes
Resmetirom's benefit in non-cirrhotic MASH did not depend on common genetic risk variants, so genotyping is not needed to select patients.
Cachexia linked to more complications after GI cancer surgery
Screen for cachexia before GI cancer surgery and involve nutrition support early; it is linked to more complications and longer stays.
A referral framework for suspected GI cancer in primary care
Refer patients with GI alarm features for endoscopy through a tiered pathway, so the most suspicious are seen first.
Albumin after large-volume paracentesis
Give albumin at 6–8 g per litre when draining more than 5 litres of ascites.
Simethicone and N-acetylcysteine in the lidocaine popsicle for unsedated endoscopy
For unsedated upper endoscopy, consider premedicating with simethicone and N-acetylcysteine alongside topical lidocaine to improve mucosal views.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for gastroenterology & hepatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free