The Effect of Oral Simethicone in a Bowel Preparation in a Colorectal Cancer Screening Colonoscopy Setting: A Randomized Controlled Trial

Apr 4, 2024GE Portuguese journal of gastroenterology

Oral Simethicone's impact on bowel cleaning for colorectal cancer screening colonoscopy: a randomized trial

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Abstract

A total of 388 patients participated, with 191 receiving PEG plus simethicone and 197 receiving PEG alone.

Adequate bowel preparation rates were similar between the PEG plus simethicone group (97%) and the PEG group (93%).
The bubble scale score was significantly lower in the PEG plus simethicone group compared to the PEG group.
Intraprocedural use of simethicone was lower in the PEG plus simethicone group (7%) than in the PEG group (37%).
No significant differences were observed in the adenoma detection rate (ADR) or the cecal intubation rate (CIR) between the groups.

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INTRODUCTION: Current guidelines suggest adding oral simethicone to bowel preparation for colonoscopy. However, its effect on key quality indicators for screening colonoscopy remains unclear. The primary aim was to assess the rate of adequate bowel preparation in split-dose high-volume polyethylene glycol (PEG), with or without simethicone.

METHODS: This is an endoscopist-blinded, randomized controlled trial, including patients scheduled for colonoscopy after a positive faecal immunochemical test. Patients were randomly assigned to 4 L of PEG split dose (PEG) or 4 L of PEG split dose plus 500 mg oral simethicone (PEG + simethicone). The Boston Bowel Preparation Scale (BBPS) score, the preparation quality regarding bubbles using the Colon Endoscopic Bubble Scale (CEBuS), ADR, CIR, and the intraprocedural use of simethicone were recorded.

RESULTS: We included 191 and 197 patients in the PEG + simethicone group and the PEG group, respectively. When comparing the PEG + simethicone group versus the PEG group, no significant differences in adequate bowel preparation rates (97% vs. 93%;= 0.11) were found. However, the bubble scale score was significantly lower in the PEG + simethicone group (0 [0] versus 2 [5],< 0.01), as well as intraprocedural use of simethicone (7% vs. 37%;< 0.01). ADR (62% vs. 61%;= 0.86) and CIR (98% vs. 96%,= 0.14) did not differ between both groups. p p p p p

CONCLUSION: Adding oral simethicone to a split-bowel preparation resulted in a lower incidence of bubbles and a lower intraprocedural use of simethicone but no further improvement on the preparation quality or ADR.

Key numbers

0 vs. 2

Bubble Scale Score Reduction

Median bubble scale score for PEG plus simethicone vs. PEG alone

7% vs. 37%

Intraprocedural Simethicone Use Reduction

Percentage of patients requiring simethicone during colonoscopy

97% vs. 93%

Adequate Bowel Preparation Rate

Adequate preparation rates for PEG plus simethicone vs. PEG alone

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The Effect of Oral Simethicone in a Bowel Preparation in a Colorectal Cancer Screening Colonoscopy Setting: A Randomized Controlled Trial

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