The effect on colon visualization during colonoscopy of the addition of simethicone to polyethylene glycol-electrolyte solution: a randomized single-blind study

Rebecca Matro, Keegan Tupchong, Constantine Daskalakis, Victoria Gordon, Leo Katz, David Kastenberg, Rebecca Matro, Keegan Tupchong, Constantine Daskalakis, Victoria Gordon, Leo Katz, David Kastenberg

Abstract

Objectives: Colonic bubbles associated with polyethylene glycol-electrolyte solution (PEG-ELS) are common and obscure mucosal visualization. This study aimed to determine whether adding simethicone decreases the incidence of bubbles.

Methods: Prospective, single-blind, randomized comparison of split dose PEG-ELS vs. PEG-ELS+simethicone (PEG-S) for outpatient colonoscopy. Bubble severity for colonic segments was assessed on withdrawal as A=no/minimal bubbles, B=moderate bubbles/interfere with detecting 5 mm polyp, C=severe bubbles/interfere with detecting 10 mm polyp. Primary end point was Grade B or C bubbles in any colon segment. Secondary end points were cleansing quality, incidence and severity of side effects, and polyp detection.

Results: One hundred and thirty nine patients enrolled; 13 withdrew before colonoscopy. Of 123 patients evaluated, 62 took PEG-S and 61 PEG-ELS. The incidence of grade B or C bubbles was much lower with PEG-S compared with PEG-ELS (2% vs. 38%; P=0.001). Overall cleansing (excellent or good) quality was not significantly different for either the whole colon (89% PEG-ELS, 94% of PEG-S, P=0.529) or right colon (88% PEG-ELS, 94% PEG-S, P=0.365). More PEG-S patients had excellent rather than good preps (whole colon 53% vs. 28%, P=0.004; right colon 53% vs. 35%, P=0.044). Need for any flushing was less with PEG-S (38% vs. 70%, P=0.001). The groups were not significantly different with respect to total procedure and withdrawal times, incidence or severity of side effects, or number of polyps/patient or adenomas/patient.

Conclusions: Adding simethicone to PEG-ELS effectively eliminates bubbles, substantially reduces the need for flushing, and results in more excellent preparations.

Figures

Figure 1
Figure 1
(a) With Polyethylene Glycol-Electrolyte Solution (PEG-ELS), 38% of patients had grade B or C bubbles in at least 1 colon segment compared with 2% with PEG-ELS+simethicone (PEG-S). (b) Preparation adequacy was similar with PEG-ELS and PEG-S. (c) Significantly less flushing was required with PEG-S. (d) Mean total procedure time and withdrawal time was not significantly different between the study groups.

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Source: PubMed

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