Efficacy of low‐dose versus high‐dose simethicone with polyethylene glycol for bowel preparation: A prospective randomized controlled trial

Mar 5, 2020Journal of gastroenterology and hepatology

Effectiveness of low versus high doses of simethicone with polyethylene glycol for bowel cleansing

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Abstract

Four hundred subjects were randomized to compare low-dose simethicone (200 mg) and high-dose simethicone (1200 mg) during bowel preparation.

No significant differences were found between low-dose and high-dose simethicone groups in total bubble scale, total bowel preparation score, adenoma detection rate, or withdrawal time.
Intubation time was significantly shorter in the low-dose simethicone group compared to the high-dose group.
Low-dose simethicone resulted in superior bubble scale scores and adenoma detection rates in the right colon.
The addition of low-dose simethicone may provide cost savings while maintaining effective bowel preparation.

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BACKGROUND AND AIM: Additional simethicone (SIM) can improve adequate bowel preparation and adenoma detection rate (ADR). However, there is no consensus on the optimal dose of SIM. In this study, we compared the adequate bowel preparation rate with supplementation of split-dose 2 L polyethylene glycol (PEG) with low-dose SIM (200 mg) versus high-dose SIM (1200 mg).

METHODS: This was a prospective, randomized, observer-blinded trial involving consecutive subjects undergoing colonoscopy. The primary outcome was adequate bowel preparation as assessed by Boston Bowel Preparation Scale (BBPS) score.

RESULTS: Four hundred subjects were randomly allocated to low-dose SIM or high-dose SIM group. Baseline characteristics were comparable in the two groups (P > 0.05). No significant between-group differences were observed with respect to total bubble scale (BS) (8.49 ± 1.00 vs 8.39 ± 1.10, P = 0.07), total BBPS score (8.70 ± 0.81 vs 8.29 ± 1.18, P = 0.98), ADR (33.68% vs 31.79%, P = 0.69) or withdrawal time (13 [range, 10-16] min vs 13 [10-15] min, P = 0.96). The intubation time in low-dose SIM group was significantly shorter than that in high-dose SIM group (8 (4-16) min vs 10 [6-17] min, P = 0.04). In addition, BS scores as well as diminutive ADR in right colon were superior in the low-dose SIM group (2.68 ± 0.59 vs 2.52 ± 0.73, P = 0.03 and 54.29% vs 30.30%, P = 0.046, respectively).

CONCLUSION: Addition of low-dose SIM to split-dose 2 L PEG was as effective as addition of high-dose SIM with respect to adequate bowel preparation, ADR and patient tolerance. However, low-dose SIM was superior with respect to intubation time, right colon BS scores, right colon diminutive ADR and cost savings.

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Efficacy of low‐dose versus high‐dose simethicone with polyethylene glycol for bowel preparation: A prospective randomized controlled trial

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