Improving quality of colonoscopy by adding simethicone to sodium phosphate bowel preparation

Abstract

AIM:To evaluate the effectiveness of simethicone in enhancing visibility and efficacy during colonoscopy. METHODS:A prospective, double-blind, randomized, placebo-controlled study was conducted. One hundred and twenty-four patients were allocated to receive 2 doses of sodium phosphate plus 240 mg of tablet simethicone or placebo as bowel preparation. Visibility was blindly assessed for the amount of air bubbles and adequacy of colon preparation. Total colonoscopic time, side effects of the medication, endoscopist and patient satisfaction were also compared. RESULTS:Sodium phosphate plus simethicone, compared to sodium phosphate plus placebo, improved visibility by diminishing air bubbles (100.00% vs 42.37%, P < 0.0001) but simethicone failed to demonstrate improvement in adequacy of colon preparation (90.16% vs 81.36%, P = 0.17). Endoscopist and patient satisfaction were increased significantly in the simethicone group. However, there was no difference in the total duration of colonoscopy and side effects of the medication. CONCLUSION:The addition of simethicone is of benefit for colonoscopic bowel preparation by diminishing air bubbles, which results in enhanced visibility. Endoscopist and patient satisfaction is also increased.

The Effect on Colon Visualization During Colonoscopy of the Addition of Simethicone to Polyethylene Glycol-Electrolyte Solution: A Randomized Single-Blind Study

“…Shaver et al 13 showed significantly better colon cleansing with simethicone and alluded to improvement in the right colon, a region more likely to be affected by adherent dense chyme. Tongprasert et al 1 showed that simethicone added to sodium phosphate improved visibility by diminishing bubbles. In the same study, there was a trend toward better colon cleansing with the addition of simethicone to sodium phosphate, though it did not reach statistical significance.…”

“…1, 2, 3 Bowel preparation may be inadequate in up to 25% of patients undergoing colonoscopy and may result in missed lesions during colorectal cancer screening. 4, 5, 6 Subsequently, reporting the adequacy of colon cleansing using one of the several available scales is an important measure of colonoscopy quality.…”

“…In fact, up to one-third of patients receiving polyethylene glycol-electrolyte solution (PEG-ELS) have bubbles at the time of colonoscopy that may potentially interfere with polyp detection. 1, 11, 12, 13, 14 Simethicone, which eliminates bubbles by decreasing surface tension, is a well-tolerated over-the-counter medication used for gas and bloating. 1, 13 …”

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

“…In a meta-analysis of 7 randomized trials comparing colonoscopy bowel purgative with or without the addition of simethicone, the overall effi cacy of colon preparation was comparable (OR, 2.06; 95% CI, 0.56-7.53; P =.27), despite a notable reduction in the presence of intraluminal bubbles (OR, 39.3; 95% CI, 11.4-135.9; P ≤.01) in the group receiving simethicone ( 172 ) . Th e dosage of simethicone varied between studies, ranging from 120-240 mg, or 45 mL of a 30% solution ( 76,(172)(173)(174) .…”

Factors influencing quality of bowel preparation for colonoscopy

“…Regardless of the type of bowel preparation used, whether it is PEG or sodium phosphate-based, both types appear to have a similar level of bowel cleansing ability. Modifications of these two common types of bowel preparations, such as adding prokinetic agents to PEG [57,58] , or adding simethicone to sodium phosphate [59] , may provide some improvements in certain instances. However, it is recognized that factors other than the type of bowel cleansing agent used, have an equally, if not more, important role in influencing the quality of bowel preparation in patients undergoing colonoscopy.…”