Simethicone use during gastrointestinal endoscopy: Position statement of the Gastroenterological Society of Australia

Abstract

Concern has been raised regarding the use of simethicone, a de-foaming agent, during endoscopic procedures. Following reports of simethicone residue in endoscope channels despite high level disinfection, an endoscope manufacturer recommended that it not be used due to concerns of biofilm formation and a possible increased risk of microorganism transmission. However, a detailed mucosal assessment is essential in performing high-standard endoscopic procedures. This is impaired by bubbles within the gastrointestinal lumen. The Gastroenterological Society of Australia's Infection Control in Endoscopy Guidelines (ICEG) Committee conducted a literature search utilizing the MEDLINE database. Further references were sourced from published paper bibliographies. Following a review of the available evidence, and drawing on extensive clinical experience, the multidisciplinary ICEG committee considered the risks and benefits of simethicone use in formulating four recommendations. Published reports have documented residual liquid or crystalline simethicone in endoscope channels after high level disinfection. There are no data confirming that simethicone can be cleared from channels by brushing. Multiple series report benefits of simethicone use during gastroscopy and colonoscopy in improving mucosal assessment, adenoma detection rate, and reducing procedure time. There are no published reports of adverse events related specifically to the use of simethicone, delivered either orally or via any endoscope channel. An assessment of the risks and benefits supports the continued use of simethicone during endoscopic procedures. Strict adherence to instrument reprocessing protocols is essential. MethodsComputerized medical literature searches were undertaken using MEDLINE, utilizing search terms "endoscopy," "gastrointestinal endoscopy," "gastroscopy," "colonoscopy," "adenoma detection rate," and "simethicone" up until September 2018. Cross

Simethicone administration improves efficacy and efficiency of esophagogastroduodenoscopy

“…Simethicone is also called poly-dimethylsiloxane, which has been introduced to remove the foam and water. Recent studies have reported that the administration of simethicone before endoscopic examination could shorten the procedure time and improve the diagnostic rate of the gastric mucosal lesions [6][7]. Although simethicone has been routinely administrated before the esophagogastroduodenoscopy, the optimal strategy of administrating simethicone has not been clearly investigated, especially the time interval from simethicone administration to the endoscopic procedure.…”

Effect of Antifoaming Agent on Colorectal Benign Tumours in Colonoscopy: A Meta-Analysis

“…Simethicone is an effective antifoaming agent during endoscopic procedures. The Gastroenterological Society of Australia consensus panel found that the current evidence supported the use of simethicone for improving visibility and likely facilitates adenoma detection at colonoscopy [33]. In addition, a recently study reported that a 10% increase in the detection rate of colorectal polyp when simethicone is added to the water pump during colonoscopy [34].…”

“…The addition of 2-3 mL of 120 mg/mL simethicone to lavage uid was recommend [33]. In the subgroup analysis, we compared the effect of the low dose simethicone (< 400 mg) versus that of high dose simethicone (≥ 400 mg) for ADR and PDR.…”

Pre-Endoscopy Drink of Simethicone and N-Acetylcysteine Significantly Improves Visualization in Upper Gastrointestinal Endoscopy

“…21 However, the technique of using simethicone as an orally taken solution is safe and does not damage the endoscope(s). 22 We thus present a simple technique of improving the mucosal visibility by using a pre-endoscopic drink of NAC + simethicone. To the best of our knowledge, this is the first Indian study evaluating the outcomes of a simple pre-endoscopy preparation.…”