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Perrin MA, Nguyen Wenker TH, Larson SA. It's All About the Bubbles: Assessing the Effects of Simethicone on Safety and Efficacy During Colonoscopy. Dig Dis Sci 2025; 70:1832-1837. [PMID: 39994087 DOI: 10.1007/s10620-025-08938-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Accepted: 02/17/2025] [Indexed: 02/26/2025]
Abstract
BACKGROUND Theoretical infection concerns prompted national Department of Veterans Affairs guidance prohibiting simethicone use in colonoscope reservoirs on January 1, 2024. AIMS We sought to determine if reservoir simethicone is associated with post-procedure infection and impact on procedure time, sedation usage, and adenoma detection rate. METHODS We conducted a retrospective cohort study of all-comers undergoing colonoscopy at Houston's Veterans Affairs hospital during September 1-30, 2023 (reservoir simethicone) and April 1-30, 2024 (aliquots administered on request [channel simethicone]). Primary outcomes were mean withdrawal and cecal intubation times. Secondary outcomes were adenoma detection rate, post-procedure 30-day infection rate, and sedation usage. We adjusted for covariates and used linear regression to determine significant predictors for mean withdrawal and intubation times. RESULTS Of 446 total colonoscopies, 211 used reservoir simethicone (47.3%) and 235 (52.7%) used channel simethicone. Mean intubation time was 8.3 min [SD ± 6.5] in the reservoir group and 9.9 min [SD ± 8.4] in the channel group (p = 0.03). Mean withdrawal time was 17.4 min [SD ± 10.2] in the reservoir group and 20.9 min [SD ± 11.9] in the channel group (p = < 0.01). Reservoir group procedures required less midazolam (p = 0.01) and fentanyl (p = 0.02). Post-operative infection (n = 1 vs n = 0; p = 0.47) and adenoma detection rate (p = 0.92) differences were not significant. CONCLUSIONS Reservoir simethicone was significantly associated with shorter intubation and withdrawal times and lower sedation usage, even after adjusting for covariates, suggesting increased efficiency with comparable infection risk.
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Affiliation(s)
- Michael A Perrin
- Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.
| | - Theresa H Nguyen Wenker
- Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Section of Gastroenterology and Hepatology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, 77030, USA
| | - Scott A Larson
- Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
- Section of Gastroenterology and Hepatology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, 77030, USA
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2
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Roy A, Goenka MK. Simethicone and N-acetyl cysteine in improving mucosal visibility: Towards a "clearer view" during endoscopy. Indian J Gastroenterol 2024; 43:863-865. [PMID: 38019375 DOI: 10.1007/s12664-023-01482-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Affiliation(s)
- Akash Roy
- Department of Gastroenterology, Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, 54 Canal Circular Road, Kolkata, 700 054, India
| | - Mahesh K Goenka
- Department of Gastroenterology, Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, 54 Canal Circular Road, Kolkata, 700 054, India.
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Anderson GG, Segars K, Sanchez AM, Weeks JW, Haugen SP, Pandey R. Effect of simethicone on the bactericidal efficacy of a high-level disinfectant. J Med Microbiol 2024; 73. [PMID: 39364734 DOI: 10.1099/jmm.0.001902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024] Open
Abstract
Introduction. Simethicone is an over-the-counter product that is frequently used by clinicians during endoscopic procedures to reduce foaming and improve visualization. Published studies have found simethicone residue on endoscopes after cleaning and disinfecting the devices as per the manufacturer's instructions. Some literature suggests that simethicone residue may reduce disinfection efficacy and increase the risk of patient infections.Gap Statement. However, there appears to be a lack of direct evidence in the literature to either disprove this or correlate simethicone presence with an increased microbial risk.Aim: Research was conducted to evaluate the in vitro impact of simethicone on disinfection efficacy.Methodology. Bacteria were grown in a microtitre plate assay in the presence of a range of simethicone concentrations and then treated with a disinfectant. Bacterial growth was assessed by spotting each microtitre well onto an agar plate.Results. The results demonstrated that, under the conditions tested, simethicone did not reduce the efficacy of Cidex ortho-phthalaldehyde disinfectant, which demonstrated at least a 6-log unit reduction in bacterial viability. Additional experiments showed that direct exposure to 66 mg ml-1 of simethicone reduced bacterial viability.Conclusion. These results indicate that simethicone may not reduce the bactericidal efficacy of disinfectant during reprocessing, under certain conditions.
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Affiliation(s)
- Gregory G Anderson
- Division of Biology, Chemistry, and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Katharine Segars
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Anastacia M Sanchez
- Division of Biology, Chemistry, and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Jon W Weeks
- Division of Biology, Chemistry, and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Shanil P Haugen
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Ruchi Pandey
- Division of Biology, Chemistry, and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, USA
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Ben Ner D, Vainer I, Toh ST, Loh S, Shofel-Havakuk H, Alkan U. Simethicone use in drug-induced sleep endoscopy improves visibility. Sleep Breath 2024; 28:807-811. [PMID: 38110601 DOI: 10.1007/s11325-023-02963-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/25/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE To assess the effect of simethicone, a defoaming agent, on improving visibility during drug-induced sleep endoscopy (DISE) in obstructive sleep apnea (OSA). METHODS The study was a retrospective case-series study on patients with OSA who failed positive airway pressure (PAP) treatment. Patient parameters were recorded including age, BMI, neck and abdominal circumference, and apnea-hypopnea index (AHI). Comparisons were made between DISE procedures performed with and without the administration of simethicone. Visibility during DISE was independently graded by two surgeons, and inter-rater reliability was assessed. RESULTS Simethicone significantly improved DISE visibility (p = 0.03). "Best visibility" was achieved in 55% of cases with simethicone compared to 27% without simethicone (p = 0.02). Sub-analysis showed that only simethicone administration had a significant effect on visibility (p = 0.02). Inter-rater reliability between the grading surgeons was strong (Cohen-Kappa score 0.7, p < 0.001). CONCLUSION The findings suggest that simethicone enhances DISE visibility for OSA surgical planning. Further research should explore optimizing simethicone administration timing and the potential clinical implications for surgical outcomes and patient care.
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Affiliation(s)
- Daniel Ben Ner
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Igor Vainer
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Song Tar Toh
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
- Singapore SingHealth Duke-NUS Sleep Centre, Singapore, Singapore
| | - Shaun Loh
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
- Singapore SingHealth Duke-NUS Sleep Centre, Singapore, Singapore
| | - Hagit Shofel-Havakuk
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Alkan
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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Speer T, Vickery K, Alfa M, Sáenz R. Minimizing the Risks of Simethicone in Endoscope Reprocessing. J Clin Gastroenterol 2023; 57:153-158. [PMID: 36508253 DOI: 10.1097/mcg.0000000000001807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 10/14/2022] [Indexed: 01/05/2023]
Abstract
This statement was written under the auspices of the World Gastroenterology Organization's Guidelines Committee. The authors are members of the Review Team of the WGO Endoscope Disinfection Guideline and have experience in endoscopy, endoscope reprocessing, and microbiology, including biofilms. During the preparation of the WGO Update on Endoscope Disinfection Guidelines, concerns about simethicone on endoscope channel surfaces compromising cleaning and disinfection were raised. Publications on simethicone, including modes of delivery, effectiveness, and risks, have been reviewed. The paper was written as a companion to the new guidelines with a focus on minimizing the risks of simethicone in endoscope reprocessing.
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Affiliation(s)
- Tony Speer
- The Royal Melbourne Hospital, Melbourne, Australia
| | | | | | - Roque Sáenz
- Facultad de Medicina, Universidad del Desarrollo, Clinica Alemana de Santiago, Santiago, Chile
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Duez L, Gkolfakis P, Bastide M, Vuckovic C, Musala C, Van Gossum M, Hoyois A, Mulkay JP, Eisendrath P. Premedication with simethicone for improving the quality of gastric mucosal visualization: a double-blind randomized controlled trial. Endosc Int Open 2022; 10:E1343-E1349. [PMID: 36262507 PMCID: PMC9576330 DOI: 10.1055/a-1922-7773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background and study aims Saliva, bubbles, or mucus can limit gastric mucosal visualization (GMV), increasing the risk of missed lesions such as gastric cancer. Several studies using endoscopy photodocumentation-based scores have reported increased quality of GMV when mucolytic and/or defoaming agents are administered. This single-center, prospective, double-blind, randomized, placebo-controlled trial aimed to evaluate whether simethicone administration could improve GMV. Patients and methods Patients were randomly assigned (1:1) to receive either 200 mg of simethicone (Group A) or placebo (Group B). Two independent endoscopists reviewed the entire video recording from each examination to assess the quality of GMV. The primary outcome was the rate of adequate GMV, defined as the percentage of patients in each group with a video score scale < 7 based on gastric visualization of five gastric landmarks. Secondary outcomes included procedure duration, patient satisfaction, and side effects. Results A total of 110 consecutive outpatients were randomly assigned to one of the two study groups (11 were excluded for various reasons). For the primary endpoint, 32 patients (61.5 %) in group A achieved adequate GMV compared to one of 47 (2.1 %) in group B (odds ratio [95 % confidence interval]: 73.6 [9.4-576.6]; P < 0.001). Median procedure time did not differ between the groups ( P = 0.55), and no differences were detected in patient satisfaction ( P = 0.18) or side effects ( P = 0.58). No serious adverse events were documented. Conclusions Premedication with simethicone before upper gastrointestinal endoscopy significantly improves the quality of GMV without affecting the duration of the examination, patient satisfaction, and the rate of side effects.
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Affiliation(s)
- Leo Duez
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Paraskevas Gkolfakis
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Marine Bastide
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Clemence Vuckovic
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Carmen Musala
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Van Gossum
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Alice Hoyois
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Pierre Mulkay
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Eisendrath
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
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Di Leo M, Iannone A, Arena M, Losurdo G, Palamara MA, Iabichino G, Consolo P, Rendina M, Luigiano C, Di Leo A. Novel frontiers of agents for bowel cleansing for colonoscopy. World J Gastroenterol 2021; 27:7748-7770. [PMID: 34963739 PMCID: PMC8661374 DOI: 10.3748/wjg.v27.i45.7748] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/23/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of colorectal cancer (CRC) is characterized by rapid declines in the wake of widespread screening. Colonoscopy is the gold standard for CRC screening, but its accuracy is related to high quality of bowel preparation (BP). In this review, we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy. Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients' acceptability. The role of the diet before colonoscopy was also changed, as well the contribution of educational intervention and the use of adjunctive drugs to improve patients' tolerance and/or quality of BP. The review also described BP in special situations, as lower gastrointestinal bleeding, elderly people, patients with chronic kidney disease, patients with inflammatory bowel disease, patients with congestive heart failure, inpatient, patient with previous bowel resection, pregnant/lactating patients. The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales. Finally, the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota. Moreover, the study underlined several points needed to further investigations.
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Affiliation(s)
- Milena Di Leo
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Monica Arena
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | | | | | - Pierluigi Consolo
- Unit of Digestive Endoscopy, University of Messina, Hospital "G. Martino", Messina 98121, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Carmelo Luigiano
- Unit of Digestive Endoscopy, San Paolo Hospital, Milan 20090, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
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Sun X, Xu Y, Zhang X, Ma C, Li A, Yu H, Zhang W, Zhang H, Yang T, Miao X, Zhang H, Liu Y, Lu Z. Simethicone administration improves gastric cleanness for esophagogastroduodenoscopy: a randomized clinical trial. Trials 2021; 22:555. [PMID: 34419109 PMCID: PMC8379843 DOI: 10.1186/s13063-021-05527-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/09/2021] [Indexed: 12/16/2022] Open
Abstract
Background Esophagogastroduodenoscopy is very useful in diagnosing and treating upper gastrointestinal mucosal disorders, but too much foam and water in stomach decrease its diagnostic efficiency. Simethicone administration can help remove excessive foam. Aims To determine the optimal simethicone administration strategies in a comparative randomized controlled clinical trial. Methods Adult outpatients with indications for esophagogastroduodenoscopy were enrolled and randomly divided into group 1 (simethicone solution intake 20–30 min before procedure, n = 110), group 2 (simethicone solution intake 31–60 min before procedure, n = 92), and group 3 (simethicone solution intake > 60 min before procedure). Primary and secondary outcomes were procedure time and the patients’ satisfaction after the examination. All symptoms like abdominal pain and distension were recorded. Results No statistically significant differences were found on the patients’ demographic and clinical features and mean examination time (all P values > 0.05). The distribution of patients with different endoscopic and pathological diagnosis was comparable among three groups, respectively (P = 0.607; P = 0.289). However, the proportion of patients with Gastric Cleanness Grade A was most in group 2 (n = 73, 79.3%), and patient proportion with Gastric Cleanness Grade C was most found in group 1 (n = 72, 65.5%), which was greatly different (P < 0.001). There was no statistically significant difference on the satisfaction scores [immediately 6 (3–8) vs. 6 (1–10) vs. 6 (1-9), P = 0.533; 2 h after 10 (8–10) vs. 10 (10–10) vs. 10 (8-10), P = 0.463]. Conclusion Simethicone solution intake 31–60 min before esophagogastroduodenoscopy can help obtain the best gastric cleanness, which is recommended in clinical practice (registered at ClinicalTrials.gov, NCT03776916 on December 13, 2018).
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Affiliation(s)
- Xiaotian Sun
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China.,Department of Internal Medicine, Beijing South Medical District, Chinese PLA General Hospital, Beijing, 100161, China
| | - Yang Xu
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Xueting Zhang
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Cuiyun Ma
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Aitong Li
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Haiyan Yu
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Weihua Zhang
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Hanqing Zhang
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Teng Yang
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Xinfang Miao
- Clinic of Fuxing Road, Beijing South Medical District, Chinese PLA General Hospital, Beijing, 100161, China
| | - Huiming Zhang
- Clinic of Fuxing Road, Beijing South Medical District, Chinese PLA General Hospital, Beijing, 100161, China
| | - Yan Liu
- Gastrointestinal Endoscopy Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China
| | - Zheng Lu
- Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, No. 100 Middle Road in Fourth West Ring, Beijing, 100039, China.
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Song Y, Zhou G, Tu M, Zhang J, Wang P. Effectiveness of oolong tea and simethicone solution for lens cleansing during colonoscopy: A double-blinded randomized study. Medicine (Baltimore) 2021; 100:e26763. [PMID: 34397820 PMCID: PMC8341282 DOI: 10.1097/md.0000000000026763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIMS water is an imperfect agent for lens cleansing during endoscopy due to its incompetence to clean hydrophobic dirt, whereas amphiphilic surfactants have the potential to overcome the limitation of water. The trial was aimed to evaluate the cleansing effectiveness of 2 typical surfactants (simethicone solution and oolong tea) for colonoscopic lens. METHODS Oolong tea (O-), low concentration simethicone solution (S1-), high concentration simethicone solution (S2-) and distilled water (D-) were used as washing solutions for colonoscopic lens. Study I: The tip of the colonoscope was immersed in lard oil in order to simulate the blur, and photographs were taken toward a standard colonoscopy image in-vitro pre- and post- each cleansing procedure. The blurred areas of each image were quantified and compared. Study II: 395 consecutive patients who were due to colonoscopy examination were enrolled and randomized into O-, S2-, D-group. The volume of washing solution used and cleansing level during the examination procedure, adenoma and polyp detected per colonoscopy, insertion time and withdraw time were analyzed. RESULTS Study I: There were no differences in 4 groups for the blurred areas on images before lens cleansing. The blurred areas after lens cleansing were significantly smaller in 3 groups (O- 8.47 ± 20.91 vs S1- 13.06 ± 10.71 vs S2- 6.76 ± 8.49 vs D- 38.24 ± 29.69, P < .05) than water. The decline range of blurred areas after lens cleansing in oolong tea, low concentration simethicone solution, high concentration simethicone solution groups were significantly higher than that in distilled water group (O- 87.35 ± 20.81 vs S1- 78.12 ± 19.24 vs S2- 89.57 ± 8.50 vs D- 53.39 ± 28.45, P < .05). Study II: The volume of washing solution used in S2-group was significantly smaller than that in O-group and D-group. The cleansing level of the colonoscopic lens of O-group was significantly superior than that of S2-group and D-group. CONCLUSIONS The in-vitro test showed oolong tea and simethicone solution can effectively cleans the colonoscopic lens. The clinical trial demonstrated that oolong tea instead of water is effective to provide better visualization during colonoscopy.Registration: Chictr.org.cn No: ChiCTR1900025606.
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Peng CL, Liu TC, Wang HP, Chang WK. Two novel protocols for cleaning residual simethicone and fluid in patient-ready duodenoscopes. J Gastroenterol Hepatol 2021; 36:1843-1850. [PMID: 33274470 DOI: 10.1111/jgh.15365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/01/2020] [Accepted: 11/29/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Approximately 42-95% of working channels have been reported to show the presence of residual fluid despite endoscope reprocessing. The aim of this study was to design two novel protocols for cleaning residual simethicone and demonstrate its efficiency by evaluating the residual fluid and cleanliness in the working channels of patient-ready duodenoscopes. METHODS The designed protocol for cleaning residual simethicone was implemented in manual cleaning and/or high-level disinfection (HLD). The residual fluid inside the working channels was estimated by visual inspection. Adenosine triphosphate (ATP) values were evaluated to determine cleanliness after manual cleaning. RESULTS Manual cleaning with novel simethicone cleaning protocol demonstrated a significant decrease in fluid droplets (14.6 ± 29.9 vs 0 ± 0, P < 0.001) and ATP values (157 ± 196 relative light units [RLUs] vs 52 ± 41 RLUs, P = 0.031). HLD with simethicone cleaning protocol, using either enzymatic detergent with effective for cleaning simethicone or cleaning time set in the automatic endoscope reprocessor program for 8 min, demonstrated significant decrease in the number of fluid droplets. Follow-up after the implementation of the simethicone cleaning protocol showed a significant decrease in fluid droplets (37.4 ± 41.0 vs 2.1 ± 5.5, P = 0.003) and ATP values (271 ± 268 RLUs vs 82 ± 136 RLUs, P = 0.021). CONCLUSIONS Simethicone cleaning protocol is advantageous for significantly decreasing fluid droplets and ATP values within endoscope working channels. After manual cleaning with the simethicone cleaning protocol, in particular, no retained fluid droplet was observed in patient-ready duodenoscopes.
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Affiliation(s)
- Chen-Ling Peng
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tao-Chieh Liu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Zhang H, Gong J, Ma LS, Jiang T, Zhang H. Effect of antifoaming agent on benign colorectal tumors in colonoscopy: A meta-analysis. World J Clin Cases 2021; 9:3607-3622. [PMID: 34046460 PMCID: PMC8130091 DOI: 10.12998/wjcc.v9.i15.3607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/25/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although several trials have shown that the addition of antifoaming agents to polyethylene glycol (PEG) can improve bowel preparation, whether PEG plus antifoaming agents have a beneficial role in the detection of benign tumors during colonoscopy has yet to be confirmed. Our aim was to clarify whether adding simethicone to PEG solution could improve the detection of benign colorectal tumors. AIM To clarify whether adding simethicone to PEG solution could improve the detection of benign colorectal tumors. METHODS The PubMed, EMBASE, and Cochrane Library databases were searched for articles published prior to September 2019. The outcomes included the detection rates of colorectal adenomas and polyps. RESULT Twenty studies were eligible. Although there was no difference in the colorectal adenoma detection rate (ADR), a significant effect of simethicone for diminutive adenomas (< 10 mm) was revealed in the group taking simethicone. We also found that simethicone could significantly improve the ADR in the proximal colon but did not affect the colorectal polyp detection rate. Furthermore, the subgroup analyses revealed a beneficial effect of simethicone on the ADR among Asians (P = 0.005) and those with an ADR < 25% (P = 0.003). Moreover, it was a significant finding that the low dose simethicone was as effective as the high dose one with respect to the detection of benign colorectal tumors. CONCLUSION In summary, the addition of simethicone to PEG might improve the detection of diminutive adenomas in the right colon by colonoscopy in Asia. Low-dose simethicone was recommended for the detection of benign colorectal tumors. However, large clinical trials are necessary to validate our results and determine the ideal dose of simethicone.
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Affiliation(s)
- Hu Zhang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
- Department of Gastroenterology, The Eighth Hospital of Wuhan, Wuhan 430014, Hubei Province, China
| | - Jing Gong
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Lin-Song Ma
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Ting Jiang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Heng Zhang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
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Zhang L, Li C, Zhao C, Zhao Z, Feng Y. Analgesic comparison of dezocine plus propofol versus fentanyl plus propofol for gastrointestinal endoscopy: A meta-analysis. Medicine (Baltimore) 2021; 100:e25531. [PMID: 33847679 PMCID: PMC8051973 DOI: 10.1097/md.0000000000025531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/23/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION As the adjunctive anesthesia to propofol, both dezocine and fentanyl showed some potential for gastrointestinal endoscopy. This meta-analysis aimed to compare their efficacy and safety. METHODS PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of dezocine versus fentanyl for the anesthesia of patients undergoing gastrointestinal endoscopy were included. RESULTS Five RCTs involving 677 patients were included in the meta-analysis. Overall, compared with fentanyl plus propofol for gastrointestinal endoscopy, dezocine plus propofol resulted in the reduction in propofol dose(mean difference [MD] = -11.72; 95% confidence interval [CI] = -22.83 to -0.61; P = .04), awakening time (std. MD = -1.79; 95% CI = -3.31 to -0.27; P = .02) and hypopnea (risk ratio [RR] = 0.16; 95% CI = 0.06-0.41; P = .0002), but had no remarkable effect on induction time (MD = 1.20; 95% CI = -0.98 to 3.39; P = .28), postoperative pain score (MD = -0.38; 95% CI = -1.00 to 0.24; P = .24), nausea or vomiting (RR = 0.45; 95% CI = 0.10-1.98; P = .29). CONCLUSION Dezocine plus propofol may be better for the anesthesia of gastrointestinal endoscopy than fentanyl plus propofol.
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Affiliation(s)
| | - Chun Li
- Department of Neurology, Jiangjin District Central Hospital, Chongqing, China
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Blanco Avellaneda CDJ, Barreto-Guevara MI, Walteros-Gordillo YL, Pinzón-Segura NA, Rivera-Velasco MDC, Bareño-Silva J. Cohortes de premedicación en endoscopia alta con Simeticona, N-acetylcisteina, Hedera helix y validación de escala visual. REVISTA COLOMBIANA DE GASTROENTEROLOGÍA 2021; 36:39-50. [DOI: 10.22516/25007440.582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
Los parámetros de calidad para endoscopia digestiva alta han introducido indicadores intraprocedimiento, dentro de los cuales la adecuada visibilidad de la mucosa, libre de saliva, moco o burbujas, puede aumentar la posibilidad de detección de lesiones en fase temprana. Sin embargo, el uso de mucolíticos y antiburbujas ha mostrado gran variabilidad de eficiencia según las soluciones, concentraciones, tiempos de exposición y escala de visibilidad aplicados.
Objetivos: determinar la efectividad de diferentes soluciones de premedicación para la limpieza de la mucosa digestiva; validar, mediante una prueba de concordancia interobservador, una nueva escala de adecuada visualización de la mucosa (TVMS) para el esófago, estómago y duodeno; y reportar eventos adversos o complicaciones relacionadas con las soluciones utilizadas y los procedimientos realizados.
Material y métodos: estudio de cohortes prospectivas comparativas. Se incluyeron 412 pacientes adultos, ASA I y ASA II, para endoscopia diagnóstica bajo sedación consciente, distribuidos en 6 cohortes similares, divididas en dos grupos: no premedicación, 2 cohortes C1 (ayuno de 6 a 8 horas)y C2 (agua 100 mL); premedicación, 4 cohortes C3 a C6 (C3: agua 100 m L + simeticona 1000 mg; C4: agua 100 mL + simeticona 200 mg + N-acetilcisteína 600 mg; C5: agua 100 mL + simeticona 200 mg + N-acetilcisteína 1000 mg; C6: agua 100 mL + simeticona 200 mg + Hedera helix 70 mg). Se ingirió la solución 15 a 30 minutos antes del paso por cricofaríngeo. Se realizó la prueba de Kappa para medir la concordancia interobservador de la escala TVMS.
Resultados: De 412 pacientes, 58 % fueron de sexo femenino; 23 % (136) fue de cohortes C1 y C2 y 67 % (276) fue de cohortes C3 a C6. El tiempo medio de exposición a cada solución fue de 24,4 minutos. El volumen de lavado para lograr una adecuada visualización fue significativamente diferente entre ambos grupos: en los pacientes con premedicación se utilizaron 75,6 mL, mientras que en los pacientes sin premedicación se utilizaron 124 mL (p = 0,000), con una calidad de TVMS excelente de 88,7 % frente al 41,4 %, respectivamente. La cohorte C4 (agua 100 mL + simeticona 200 mg + N-acetilcisteína 600 mg) mostró ser la más efectiva con una diferencia significativa (p = 0,001) frente a C1 (ayuno) y C2 (placebo con agua 100 mL), y también tuvo una eficiencia superior frente a C3, C5 y C6 en su orden. No se presentaron eventos adversos o complicaciones en relación con la endoscopia, la sedación y los productos usados en la premedicación.
Conclusiones: la solución más efectiva como premedicación para lograr una excelente visibilidad de la mucosa digestiva correspondió a la cohorte C4 (SIM 200 + NAC 600 + H2O 100 mL). La escala TVMS propuesta es una herramienta muy completa y fácil de aplicar por más de un observador. La premedicación ingerida, con antiburbuja, mucolítico y agua hasta 100 mL, entre 15 y 30 minutos previos a endoscopia, es segura en las condiciones descritas en este estudio.
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Zimmer V. Intraductal simethicone application for optimization of endoscopic view on direct cholangioscopy. Ann Gastroenterol 2020; 33:689. [PMID: 33162749 PMCID: PMC7599346 DOI: 10.20524/aog.2020.0512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Vincent Zimmer
- Department of Medicine, Marienhausklinik St. Josef Kohlhof, Neunkirchen, Germany (Vincent Zimmer).,Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg (Vincent Zimmer), Germany
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PAHOMEANU MR, NEGREANU L. Recent Advances in Colonic Preparation for an Accurate Colonoscopy - How to Improve Our Practice to Meet the Quality Criteria. MEDICINA MODERNA - MODERN MEDICINE 2020; 27:139-144. [DOI: 10.31689/rmm.2020.27.3.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Colorectal cancer (CRC) remains a major problem of global health. Screening colonoscopy is the gold standard in detection of CRC. A quality colonoscopy needs good indication, adequate bowel preparation, adequate examination time (30 to 45 minutes), a minimum 6 minutes time for mucosal examination during colonoscopy descent, a good centre adenoma detection rate. In 28-33% of the colonoscopies, the bowel preparation is unsatisfactory which leads to several hidden costs including the rise of preventable and treatable death rate regarding colorectal carcinoma. The ESGE (European Society of Gastrointestinal Endoscopy) recommends a maximum of 10% poor preparations, threshold that is diffi cult to reach in many centres. Newer low-volume laxative regimens for bowel cleansing are better in the fi elds of compliance and tolerability than the classic 4L PEG with 2L PEG-CS (Clensia ®) being one of the new promising low-volume formulas. The low fi bre diet is now preferred due to better compliance and tolerability.
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Affiliation(s)
- Mihai-Radu PAHOMEANU
- 2nd Department of Gastroenterology, Emergency University Hospital, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Lucian NEGREANU
- 2nd Department of Gastroenterology, Emergency University Hospital, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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