The potential benefit of oral simethicone in improving colonic visualization and polyp detection in routine colonoscopy screenings

Suwanee, GA

Introduction: Colon cancer is the second leading cause of cancer deaths in the United States among men and women. Many of these cancers can be prevented through regular colonoscopy screening. However, the bowel preps used prior to the screening procedure create a frothy or “bubbly” appearance within the colon. Physicians have tried to overcome this with the flushing of water or using simethicone in the water canister during the procedure, but they have provided minimal efficacy and simethicone damages the colonoscope. As a result, physicians have a difficult time viewing the colonic mucosa and thoroughly inspecting the colon for polyps.

Objectives: This study aims to objectively determine if the use of simethicone (Gas X) taken orally after taking the bowel prep has 2 advantages, improving quality of preparation and subsequent increase in polyp detection.

Methods: This will be a randomized, single-blinded study comparing a split-dose bowel prep with and without the use of oral simethicone in patients undergoing routine colonoscopy screenings. Both groups will be provided with a standard bowel prep kit. Patients will be randomly assigned prior to receiving their bowel prep kits. Only the patients within the experimental group will additionally receive a single dose of simethicone with their bowel prep. Each patient will receive clear prep instructions, as attached to this proposal. The patients will be informed to drink clear liquids one day prior to the procedure, with no consumption of solid foods and dairy. On the day before their procedure they will be informed to drink their first 5.4-oz bottle at 6 pm the day before their procedure with 40 oz of clear liquids and their second 5.4 oz bottle 5 hours before the morning of their colonoscopy with 24 oz of clear liquids. Patients in the experimental group will be provided with additional instructions informing them to take their given dose of simethicone (Gas-X) approximately 30 minutes after the completion of their second bottle in the preparation.

Results: The control group (n=7) showed that 57% of the subjects presented with froth whereas the remainder presented with little froth. One patient was removed due to very poor prep that allowed for minimal visualization of the colon. The experimental group (n=5) showed 100% with no froth during colonoscopy. Post-procedure results showed that 42% of the control group complained of bloating, nausea, and mild discomfort. No participant in the experimental group complained of post-procedure symptoms expressed by the control group.

Conclusion: Preliminary results show that more participants are needed to accurately compare the control and experimental group. Based on current results, simethicone does seem to provide some assistance in colonic visualization and overall improvement in patient symptoms following colonoscopy. Additionally, the use of simethicone has shown improved symptoms in the setting of bowel prep for colonoscopy. However, this is not yet statistically significant and requires longer continuation of study.