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

Yu Bai; Jun Fang; Sheng-Bing Zhao; Dong Wang; Yan-Qing Li; Rui-Hua Shi; Zi-Qin Sun; Ming-Jun Sun; Feng Ji; Jian-Min Si; Zhao-Shen Li

doi:10.1055/s-0043-119213

Endoscopy, Table of Contents

Endoscopy 2018; 50(02): 128-136
DOI: 10.1055/s-0043-119213

Original article

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

Yu Bai^*

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Jun Fang^*

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

²Department of Gastroenterology, Zhongnan Hospital of Wuhan University; Wuhan, China

,

Sheng-Bing Zhao

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Dong Wang

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

,

Yan-Qing Li

³Department of Gastroenterology, Qilu Hospital, Shandong University, Ji'nan, Shandong Province, China

,

Rui-Hua Shi

⁴Department of Gastroenterology, Zhongda Hospital of Southeast University, Nanjing, Jiangsu Province, China

,

Zi-Qin Sun

⁵Department of Gastroenterology, General Hospital of Jinan Military Command, ShiFan Street 25, Jinan, Shandong Province 250031, China

,

Ming-Jun Sun

⁶Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China

,

Feng Ji

⁷Department of Gastroenterology, The First Affiliated Hospital of Medical College of Zhejiang University, Hangzhou, Zhejiang, China

,

Jian-Min Si

⁸Department of Gastroenterology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China

,

Zhao-Shen Li

¹Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

› Author Affiliations

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.

Full Text

References

References
1 Torre LA, Bray F, Siegel RL. et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87-108
2 Arnold M, Sierra MS, Laversanne M. et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut 2017; 66: 683-691
3 Meester RG, Doubeni CA, Lansdorp-Vogelaar I. et al. Variation in adenoma detection rate and the lifetime benefits and cost of colorectal cancer screening: a microsimulation model. JAMA 2015; 313: 2349-2358
4 Corley DA, Levin TR, Doubeni CA. Adenoma detection rate and risk of colorectal cancer and death. NEJM 2014; 370: 2541
5 Sung JJ, Ng SC, Chan FK. et al. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening. Gut 2015; 64: 121-132
6 Kim HW. Inadequate bowel preparation increases missed polyps. Clin Endosc 2012; 45: 345-346
7 Matro R, Tupchong K, Daskalakis C. et al. The effect on colon visualization during colonoscopy of the addition of simethicone to polyethylene glycol-electrolyte solution: a randomized single-blind study. Clin Transl Gastroenterol 2012; 3: e26
8 Brecevic L, Bosan-Kilibarda I, Strajnar F. Mechanism of antifoaming action of simethicone. J Appl Toxicol 1994; 14: 207-211
9 Park JJ, Lee SK, Jang JY. et al. The effectiveness of simethicone in improving visibility during colonoscopy. Hepatogastroenterology 2009; 56: 1321-1325
10 Shaver WA, Storms P, Peterson WL. Improvement of oral colonic lavage with supplemental simethicone. Dig Dis Sci 1988; 33: 185-188
11 Pontone S, Angelini R, Standoli M. et al. Low-volume plus ascorbic acid vs high-volume plus simethicone bowel preparation before colonoscopy. World J Gastroenterol 2011; 17: 4689-4695
12 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
13 Fang J, Wang SL, Fu HY. et al. Impact of gum chewing on the quality of bowel preparation for colonoscopy: an endoscopist-blinded, randomized controlled trial. Gastrointest Endosc 2017; 86: 187-191
14 Fang J, Fu HY, Ma D. et al. Constipation, fiber intake and non-compliance contribute to inadequate colonoscopy bowel preparation: a prospective cohort study. J Dig Dis 2016; 17: 458-463
15 Lai EJ, Calderwood AH, Doros G. et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69: 620-625
16 Calderwood AH, Jacobson BC. Comprehensive validation of the Boston Bowel Preparation Scale. Gastrointest Endosc 2010; 72: 686-692
17 McNally PR, Maydonovitch CL, Wong RK. The effectiveness of simethicone in improving visibility during colonoscopy: a double-blind randomized study. Gastrointest Endosc 1988; 34: 255-258
18 Lazzaroni M, Petrillo M, Desideri S. et al. Efficacy and tolerability of polyethylene glycol-electrolyte lavage solution with and without simethicone in the preparation of patients with inflammatory bowel disease for colonoscopy. Aliment Pharmacol Ther 1993; 7: 655-659
19 McNally PR, Maydonovitch CL, Wong RK. The effect of simethicone on colonic visibility after night-prior colonic lavage. A double-blind randomized study. J Clin Gastroenterol 1989; 11: 650-652
20 Bai Y, Gao J, Zou DW. et al. Distribution trends of colorectal adenoma and cancer: a colonoscopy database analysis of 11,025 Chinese patients. J Gastroenterol Hepatol 2010; 25: 1668-1673
21 Pox C, Schmiegel W. Colorectal screening in Germany. Z Gastroenterol 2008; 46 Suppl 1: S31-S32
22 Bleiker EM, Menko FH, Taal BG. et al. Screening behavior of individuals at high risk for colorectal cancer. Gastroenterology 2005; 128: 280-287
23 Wexner SD, Beck DE, Baron TH. et al. A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Gastrointest Endosc 2006; 63: 894-909
24 Froehlich F, Wietlisbach V, Gonvers JJ. et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc 2005; 61: 378-384
25 Chiu HM, Lin JT, Wang HP. et al. The impact of colon preparation timing on colonoscopic detection of colorectal neoplasms--a prospective endoscopist-blinded randomized trial. Am J Gastroenterol 2006; 101: 2719-2725
26 Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc 2003; 58: 76-79
27 Wu L, Cao Y, Liao C. et al. Systematic review and meta-analysis of randomized controlled trials of Simethicone for gastrointestinal endoscopic visibility. Scand J Gastroenterol 2011; 46: 227-235
28 Yoo IK, Jeen YT, Kang SH. et al. Improving of bowel cleansing effect for polyethylene glycol with ascorbic acid using simethicone: A randomized controlled trial. Medicine (Baltimore) 2016; 95: e4163
29 Parente F, Vailati C, Bargiggia S. et al. 2-Litre polyethylene glycol-citrate-simethicone plus bisacodyl versus 4-litre polyethylene glycol as preparation for colonoscopy in chronic constipation. Dig Liver Dis 2015; 47: 857-863
30 Saltzman JR, Cash BD, Pasha SF. et al. Bowel preparation before colonoscopy. Gastrointest Endosc 2015; 81: 781-794
31 Hassan C, Bretthauer M, Kaminski MF. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013; 45: 142-150
32 Gao Y, Lin JS, Zhang HD. et al. Pilot validation of the Boston Bowel Preparation Scale in China. Dig Endosc 2013; 25: 167-173