Endoscopy 2018; 50(02): 128-136
DOI: 10.1055/s-0043-119213
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Yu Bai*
1  Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
,
Jun Fang*
1  Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
2  Department of Gastroenterology, Zhongnan Hospital of Wuhan University; Wuhan, China
,
Sheng-Bing Zhao
1  Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
,
Dong Wang
1  Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
,
Yan-Qing Li
3  Department of Gastroenterology, Qilu Hospital, Shandong University, Ji'nan, Shandong Province, China
,
Rui-Hua Shi
4  Department of Gastroenterology, Zhongda Hospital of Southeast University, Nanjing, Jiangsu Province, China
,
Zi-Qin Sun
5  Department of Gastroenterology, General Hospital of Jinan Military Command, ShiFan Street 25, Jinan, Shandong Province 250031, China
,
Ming-Jun Sun
6  Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China
,
Feng Ji
7  Department of Gastroenterology, The First Affiliated Hospital of Medical College of Zhejiang University, Hangzhou, Zhejiang, China
,
Jian-Min Si
8  Department of Gastroenterology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
,
Zhao-Shen Li
1  Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
› Author Affiliations
TRIAL REGISTRATION: Multi-center, Randomized trial NCT02540239 at clinicaltrials.gov.
Further Information

Publication History

submitted 20 February 2017

accepted after revision 09 July 2017

Publication Date:
06 October 2017 (eFirst)

Abstract

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 %, P = 0.04; advanced ADR 9.0 % vs. 7.0 %, P = 0.38). The mean number of adenomas detected was 2.20 ± 1.36 vs. 1.63 ± 0.89 (P = 0.02). Patients in the PEG plus simethicone group showed better bowel cleansing efficacy: BBPS ≥ 6 in 88.3 % vs. 75.2 % (P < 0.001) and bubble scores of 1.00 ± 1.26 vs. 3.98 ± 2.50 (P < 0.001). Abdominal bloating was reported less frequently in the PEG plus simethicone group (7.8 % vs. 19.7 %, P < 0.001) than in the PEG alone group.

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

* Co-first authors