Impact of preprocedure simethicone on adenoma detection rate during colonoscopy: a multicenter, endoscopist-blinded randomized controlled trial

Oct 7, 2017Endoscopy

Using simethicone before colonoscopy may improve detection of precancerous polyps

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Abstract

In a study of 583 patients, the adenoma detection rate (ADR) was 21.0% for those receiving polyethylene glycol (PEG) with simethicone compared to 14.3% for PEG alone.

The mean number of adenomas detected was 2.20 in the PEG plus simethicone group versus 1.63 in the PEG alone group.
Patients receiving PEG with simethicone had a higher quality of bowel preparation, with 88.3% achieving a Boston bowel preparation scale (BBPS) score of 6 or higher compared to 75.2% in the PEG alone group.
Bubble scores indicating foam presence were significantly lower in the PEG plus simethicone group (1.00) compared to the PEG alone group (3.98).
Abdominal bloating was reported less frequently in the PEG plus simethicone group (7.8%) compared to the PEG alone group (19.7%).

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BACKGROUND AND STUDY AIMS: Ideal bowel preparation for colonoscopy requires complete removal of fluid and foam from the colon. Polyethylene glycol (PEG) is widely used for bowel preparation, with antifoaming agents such as simethicone commonly used in combination with PEG. Data on the effect of simethicone on the adenoma detection rate (ADR) were limited. This study therefore aimed to investigate whether preprocedure simethicone could increase the ADR.

PATIENTS AND METHODS: This was a prospective, multicenter, endoscopist-blinded randomized controlled trial involving consecutive patients who underwent colonoscopy in six centers in China. Patients were randomly assigned to one of two groups: PEG plus simethicone or PEG alone. The primary outcome was ADR; secondary outcomes were quality of bowel preparation, measured by the Boston bowel preparation scale (BBPS) and bubble scores.

RESULTS: 583 patients were included. More adenomas were detected in the PEG plus simethicone group than in the PEG alone group (ADR 21.0 % vs. 14.3 %, = 0.04; advanced ADR 9.0 % vs. 7.0 %, = 0.38). The mean number of adenomas detected was 2.20 ± 1.36 vs. 1.63 ± 0.89 ( = 0.02). Patients in the PEG plus simethicone group showed better bowel cleansing efficacy: BBPS ≥ 6 in 88.3 % vs. 75.2 % ( < 0.001) and bubble scores of 1.00 ± 1.26 vs. 3.98 ± 2.50 ( < 0.001). Abdominal bloating was reported less frequently in the PEG plus simethicone group (7.8 % vs19.7 %, < 0.001) than in the PEG alone group. P P P P P. P

CONCLUSION: Combined use of PEG and simethicone is associated with a significantly increased ADR in a Chinese population.

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Impact of preprocedure simethicone on adenoma detection rate during colonoscopy: a multicenter, endoscopist-blinded randomized controlled trial

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