A randomized controlled trial of high volume simethicone to improve visualization during capsule endoscopy

Abstract

Background The optimal dose of simethicone before capsule endoscopy is unknown. Prior studies have reported inconsistent cleansing, with some showing improved visualization only in the proximal small intestine. We hypothesized a higher volume of simethicone may improve cleansing and diagnostic yield, especially in the distal small bowel. Methods A phase III randomized controlled trial was conducted comparing high volume (1125 mg simethicone in 750 ml water) versus standard volume (300 mg simethicone in 200 ml water) solutions, both at 1.5 mg/ml. The primary outcome was adequate bowel preparation, defined as a KOrea-CanaDA (KODA) score >2.25, overall and stratified by the proximal and distal half of the small bowel. Secondary outcomes included mean KODA score, diagnostic yield, completion rate, and adverse events. All analyses were intention-to-treat. Results A total of 167 patients were randomized (mean (SD) age 58.7 (15.7), 54% female) and the most common indication was obscure gastrointestinal bleeding (71.7%). Adequate cleansing was achieved in 39 (50%) patients in the high volume group and in 39 (48%) patients in the standard volume group (RR 1.04, 95% CI 0.76–1.43, p = 0.82), with no differences observed in the proximal half (71% vs 64%, p = 0.40) or the distal half -of the small bowel (36% vs. 37%, p = 0.88). There was no differences in the mean (SD) KODA score (2.20 (0.41) vs. 2.18 (0.44), p = 0.73), diagnostic yields (53% vs. 56%, p = 0.71), or completion rates (both 95%). One adverse event, nausea, occurred in the control group. Conclusion High volume simethicone does not improve visualization during capsule endoscopy. Clinical trial registration Clinical trial: NCT02334631.

Evaluation by a Machine Learning System of Two Preparations for Small Bowel Capsule Endoscopy: The BUBS (Burst Unpleasant Bubbles with Simethicone) Study

“…Still, up to now, studies based on human analysis remain controversial regarding any SB cleanliness improvement with simethicone [ 5 , 7 , 29 ]. In a recent randomized trial, a preparation with a high dose of simethicone did not significantly improve the SB cleanliness compared to a standard preparation, as assessed by human readers [ 30 ]. Our study, based on AI analysis, strengthens this finding: the overall cleanliness of the SB (as measured by the R/G score) was not significantly improved when using the simethicone-based preparation.…”

Lavage, Simethicone, and Prokinetics—What to Swallow with a Video Capsule

“…However, a recent randomized trial found no improvement of mucosal visualization by high-dose simethicone (1125 mg) compared to standard dose (300 mg) additionally to PEG based lavage the day before SBCE. [ 13 ]. A score with four grades has been used for human operator assessment: no intraluminal gas; no/moderate/severe limitation of visibility by intraluminal foam/gas bubbles [ 14 ] ( Figure 1 ).…”

Small-Bowel Capsule Endoscopy—Optimizing Capsule Endoscopy in Clinical Practice

“…There is no consensus on the optimal dose of simethicone, with ranges between 80 to 200 mg used [19]. A recent trial of high-dose simethicone (1125 mg in 750 mL of water) did not show any benefit for the high dose versus a standard dose of 300 mg [23].…”