Improving of bowel cleansing effect for polyethylene glycol with ascorbic acid using simethicone

Abstract

Background and Aim:Low-volume polyethylene glycol with ascorbic acid (PEG-Asc) use is reported to be as safe and effective as traditional 4-L polyethylene glycol use. However, PEG-Asc produces bubbles, which cause problems during colonoscopy. Data on the effects of using antifoaming agents such as simethicone with PEG-Asc are lacking. The aim of this CONSORT-prospective, randomized, observer-blinded, controlled trial is to compare the quality of bowel preparation and compliance between PEG-Asc users and PEG-Asc plus simethicone users.Methods:Adult outpatients aged 18 to 80 years undergoing colonoscopy were recruited to the study. Two hundred sixty patients were randomly assigned to 1 of 2 treatment arms, PEG-Asc or PEG-Asc plus simethicone. The primary outcome measure was the bowel cleansing quality using Boston bowel preparation scale and bubble scores. The secondary outcome measures were patient tolerability and doctor tolerability.Results:The simethicone group showed superior cleansing results (6–9 Boston scale scores: 99% vs. 84%, <5% bubble scores: 96% vs. 49%, P < 0.001) and fewer gastrointestinal symptoms (abdominal fullness: 24% vs. 55%, colicky pain: 5% vs. 24%, P < 0.001) than the non-simethicone group. Moreover, endoscopist fatigue during colonoscopy was lower in the simethicone group than in the non-simethicone group (1.31 ± 0.75 vs. 2.97 ± 2.14, P < 0.001).Conclusion:PEG-Asc plus simethicone use was more effective and associated with better patient and endoscopist tolerance than PEG-Asc use. Therefore, this combination is recommended as one of the promising methods for bowel preparation before colonoscopy.

Effect of supplemental simethicone for bowel preparation on adenoma detection during colonoscopy: A meta‐analysis of randomized controlled trials

“…After listing the ADR in individual RCTs, the researchers decided to perform a post hoc subgroup analysis of the effect of SIM on ADR stratified according to the baseline ADR (the ADR in the non‐SIM group), due to the large gap between the highest ADR (46.4%; Yoo et al …”

“…In order to improve the level of bowel cleansing, simethicone (SIM), a kind of oral antifoaming agent, has been added to several PEG‐based bowel preparation regimens, for it reduces bubbles in bowel segments so as to improve visualization of the colonic mucosa and promote emission of excessive gas …”

“…Although several randomized controlled trials (RCTs) have reported that supplemental SIM can improve bowel preparation, there is no consensus as to whether it can ultimately increase the ADR during colonoscopy, which is more clinically concerned to the prevention of CRC. Two RCTs have reported the significantly high ADR in SIM group, but other several RCTs have revealed inconsistent conclusions . Thus, to date, it is still unclear whether supplemental SIM for bowel preparation could increase ADR during colonoscopy.…”

Influence of Simethicone Added to the Rinse Water during Colonoscopies on Polyp Detection Rates: Results of an Unintended Cohort Study

“…Similarly, modifications of the bowel preparation prescribed such as the addition of coffee [13] or the addition of simethicone as an anti-foaming agent [14]. A number of studies have demonstrated that the addition of simethicone to the bowel preparation improved the visibility [12,15] and a systematic review concluded that supplemental use of oral simethicone before endoscopy improves the small bowel visibility, decreases air bubbles in the colonic lumen but does not affect the completion rate of colonoscopies [16]. There is also improved visibility with pre-medication using simethicone before esophagogastroduodenoscopy [17,18].…”

“…On the other hand, it is well established that the quality of the bowel preparation with regard to polyp and adenoma detection rates is critical [9]. Numerous measures such as single vs. split prep bowel preparation have been tested and split prep has been shown to result in better adenoma detection rates [10][11][12]. Similarly, modifications of the bowel preparation prescribed such as the addition of coffee [13] or the addition of simethicone as an anti-foaming agent [14].…”