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Bowel prep with simethicone improved visualization during colonoscopy
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Simethicone added to bowel preparation for colonoscopy reduced colonic bubbles and improved visualization during the procedure in a recent study.
In a prospective, single-blind study, researchers randomly assigned 61 patients undergoing elective outpatient colonoscopy to receive a split dose of 2 L polyethylene glycol-electrolyte solution (PEG-ELS) and 62 to receive split dose PEG-ELS with 400 mg simethicone (PEG-S) at each dose as bowel preparation.
Upon colonoscopy, the presence of moderate or severe bubbles interfering with the detection of polyps was assessed and compared between groups, along with prep quality, polyp detection and the incidence and severity of side effects.
David Kastenberg
“I’ve been bothered by colonic bubbles and the need to spend time flushing for a while,” researcher David Kastenberg, MD, FACP, AGAF, associate professor of medicine at Thomas Jefferson University Hospital, told Healio.com. “I developed a validated scale to grade small bowel cleansing for capsule endoscopy by reviewing many studies and jotting down the factors that interfered with my getting a really good look at the small bowel. … My concern is that doctors may just tolerate bubbles, not do the flushing, and miss lesions.”
Colonic bubbles were detected in 24 participants, with all but one in the PEG-ELS group (P=.001 for difference). Severe bubbles were observed in eight cases, all in the PEG-ELS group. Preparation was rated as “good” or “excellent” quality frequently for both groups (94% for PEG-S vs. 89% for PEG-ELS; P=.529), but the PEG-S group had “excellent” prep more frequently, both overall (53% of cases vs. 28%; P=.004) and specifically in the right colon (53% vs. 35%; P=.044).
No significant differences were observed between groups regarding procedure length or withdrawal time, patients with polyps, polyp count or adenomas detected per patient or the incidence or severity of side effects.
“Adding simethicone to the colon prep virtually eliminates all colonic bubbles and reduces flushing during the procedure,” Kastenberg said, adding that the solution is inexpensive and safe. “Future directions would evaluate whether other endpoints are superior — polyp detection, patient satisfaction/fewer adverse events, and more efficient procedures. A study many times greater in size will be needed.”
Disclosure: Kastenberg has applied for a patent for PEG-S.
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