THE EFFECT OF ORAL SIMETHICONE IN A BOWEL PREPARATION IN A COLORECTAL CANCER SCREENING COLONOSCOPY SETTING: AN ENDOSCOPIST-BLINDED RANDOMIZED CONTROLLED TRIAL INTERIM ANALYSIS

Aims Current ESGE guideline suggests 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 regarding bubbles, in split-dose high-volume polyethylene glycol (PEG), with or without simethicone. Secondary aims included adenoma detection rate (ADR), caecal intubation rate (CIR), intraprocedural use of simethicone and patient’s compliance.

Methods Endoscopist-blinded, randomized controlled trial, included patients scheduled for colonoscopy after a positive faecal immunochemical test. Computer-generated randomization and opaque envelope concealed allocation. Patients randomly assigned to: PEG split-dose (group A) or PEG split-dose plus 500mg oral simethicone (group B). Quality preparation assessed by a bubble scale in 5 segments (0-perfect, 15-worse). Boston Bowel Preparation Scale (BBPS), ADR, CIR, intraprocedural use of simethicone and patient’s compliance were recorded.

Results We included 152 and 110 patients in groups A and B, respectively. Comparing groups A- PEG vs. Group B-PEG+Simethicone, the bubble scale score was significantly lower in group B (2 vs. 0, P<0.01) and also the intraprocedural use of simethicone (33.6% vs. 8.2%; P<0.01). No significant differences between groups were seen regarding adequate bowel preparation rate (92.7% vs. 96.4%; P=0.21), ADR (59.2% vs. 58.2%; P=0.87), CIR (94.7% vs. 98.2%, P=0.15) and patient’s compliance (8 vs. 8, P=0.9).

Conclusions Adding oral simethicone to a split bowel preparation provided better visualization regarding bubbles and less intraprocedural use of simethicone with similar patient compliance but no further improvement in quality of preparation or ADR.

Publication History

Article published online:
14 April 2022