Download PDF
Endoscopy 2018; 50(04): 412-422
DOI: 10.1055/s-0043-121337
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Simethicone improves bowel cleansing with low-volume polyethylene glycol: a multicenter randomized trial

Shenghong Zhang   *
1   Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
,
Danping Zheng   *
1   Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
,
Jinping Wang
1   Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
,
Jianwei Wu
2   Division of Gastroenterology, The Eighth Hospital of Shenzhen, Shenzhen, PR China
,
Pingguang Lei
3   Division of Gastroenterology, Shenzhen Bao'an District Songgang People's Hospital, Shenzhen, PR China
,
Qi Luo
4   Division of Endoscopy, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, PR China
,
Liping Wang
5   Division of Gastroenterology, The Second People’s Hospital of Foshan, Foshan, PR China
,
Beiping Zhang
6   Division of Gastroenterology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, PR China
,
Hong Wang
7   Division of Gastroenterology, The First People’s Hospital of Guangzhou, Guangzhou, PR China
,
Yi Cui
1   Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
,
Minhu Chen
1   Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
› Author AffiliationsTRIAL REGISTRATION: International Standard Randomized Controlled Trials ChiCTR-IPR-15006181 at http://www.chictr.org.cn.
Further Information

Publication History

submitted 14 March 2017

accepted after revision 12 September 2017

Publication Date:
13 November 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Background and study aims For bowel preparation, using a reduced volume of polyethylene glycol (PEG) solution without influencing its effectiveness would be preferable. While simethicone shows great potential as an adjunctive agent, data on its use are limited. We aimed to clarify whether simethicone added to low-volume PEG solution improved bowel cleansing.

Patients and methods Consecutive adult patients registered for colonoscopy were recruited from seven medical centers in South China between 15 April and 15 July 2015 and prospectively randomized into two groups: 2 L PEG (conventional group) and 2 L PEG plus simethicone (simethicone group). The primary endpoint was the effectiveness of bowel cleansing according to the Boston Bowel Preparation Scale (BBPS). Secondary endpoints included cecal intubation time, adenoma detection rate (ADR), patient safety and compliance, and adverse events.

Results We included 290 and 289 patients in the conventional and simethicone groups, respectively, for analysis. The proportion with acceptable bowel cleansing (BBPS ≥ 6) was significantly higher in the simethicone group than in the conventional group (88.2 % vs. 76.6 %; P < 0.001). The mean (SD) BBPS score was significantly lower in the conventional group (6.5 [1.8] vs. 7.3 [1.7]; P < 0.001), as was the bubble score (2.5 [0.7] vs. 2.8 [0.5]; P < 0.001). The average cecal intubation time was significantly shorter in the simethicone group (6.3 [3.1] vs. 7.5 [5.1] minutes; P < 0.001). The ADR in the right colon was higher in the simethicone group than in the conventional group (16.6 % vs. 10.3 %; P = 0.03). Safety and compliance, including the taste, smell, and dosage of PEG, were similar for both groups.

Conclusions Simethicone added to low-volume PEG solution improves bowel-cleansing efficacy, with similar safety and compliance, shorter cecal intubation time, and higher ADR.

* These authors contributed equally to the work


Table e3, e5

 

  • References

  • 1 Lei P, Gu F, Hong L. et al. Pediatric colonoscopy in South China: a 12-year experience in a tertiary center. PLoS One 2014; 9: e95933
    CrossrefPubMedSearch in Google Scholar
  • 2 Zhang S, Li M, Zhao Y. et al. 3-L split-dose is superior to 2-L polyethylene glycol in bowel cleansing in Chinese population: a multicenter randomized, controlled trial. Medicine (Baltimore) 2015; 94: e472
    CrossrefPubMedSearch in Google Scholar
  • 3 Chokshi RV, Hovis CE, Hollander T. et al. Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy. Gastrointest Endosc 2012; 75: 1197-1203
    CrossrefPubMedSearch in Google Scholar
  • 4 Lebwohl B, Kastrinos F, Glick M. et al. The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy. Gastrointest Endosc 2011; 73: 1207-1214
    CrossrefPubMedSearch in Google Scholar
  • 5 Hassan C, Bretthauer M, Kaminski MF. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013; 45: 142-150
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Enestvedt BK, Tofani C, Laine LA. et al. 4-Liter split-dose polyethylene glycol is superior to other bowel preparations, based on systematic review and meta-analysis. Clin Gastroenterol Hepatol 2012; 10: 1225-1231
    CrossrefPubMedSearch in Google Scholar
  • 7 Chinese Society for Gastrointestinal Endoscopy. Chinese consensus on bowel preparation before endoscopy. Chin J Pract Int Med 2013; 33: 705-707
    PubMedSearch in Google Scholar
  • 8 Johnson DA, Barkun AN, Cohen LB. et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Gastroenterology 2014; 147: 903-924
    CrossrefPubMedSearch in Google Scholar
  • 9 Moon CM, Park DI, Choe YG. et al. Randomized trial of 2-L polyethylene glycol+ascorbic acid versus 4-L polyethylene glycol as bowel cleansing for colonoscopy in an optimal setting. J Gastroenterol Hepatol 2014; 29: 1223-1228
    CrossrefPubMedSearch in Google Scholar
  • 10 Xie Q, Chen L, Zhao F. et al. A meta-analysis of randomized controlled trials of low-volume polyethylene glycol plus ascorbic acid versus standard-volume polyethylene glycol solution as bowel preparations for colonoscopy. PLoS One 2014; 9: e99092
    CrossrefPubMedSearch in Google Scholar
  • 11 Connor A, Tolan D, Hughes S. et al. Consensus guidelines for the safe prescription and administration of oral bowel-cleansing agents. Gut 2012; 61: 1525-1532
    CrossrefPubMedSearch in Google Scholar
  • 12 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
    CrossrefPubMedSearch in Google Scholar
  • 13 Park S, Lim YJ. Adjuncts to colonic cleansing before colonoscopy. World J Gastroenterol 2014; 20: 2735-2740
    CrossrefPubMedSearch in Google Scholar
  • 14 Tongprasert S, Sobhonslidsuk A, Rattanasiri S. Improving quality of colonoscopy by adding simethicone to sodium phosphate bowel preparation. World J Gastroenterol 2009; 15: 3032-3037
    CrossrefPubMedSearch in Google Scholar
  • 15 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
    CrossrefPubMedSearch in Google Scholar
  • 16 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
    CrossrefPubMedSearch in Google Scholar
  • 17 Parmar R, Martel M, Rostom A. et al. Validated scales for colon cleansing: a systematic review. Am J Gastroenterol 2016; 111: 197-204
    CrossrefPubMedSearch in Google Scholar
  • 18 Brahmania M, Ou G, Bressler B. et al. 2 L versus 4 L of PEG3350 + electrolytes for outpatient colonic preparation: a randomized, controlled trial. Gastrointest Endosc 2014; 79: 408-416
    CrossrefPubMedSearch in Google Scholar
  • 19 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
    CrossrefPubMedSearch in Google Scholar
  • 20 Yoo IK, Lee JS, Chun HJ. et al. A randomized, prospective trial on efficacy and tolerability of low-volume bowel preparation methods for colonoscopy. Dig Liver Dis 2015; 47: 131-137
    CrossrefPubMedSearch in Google Scholar
  • 21 Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc 2004; 59: 482-486
    CrossrefPubMedSearch in Google Scholar
  • 22 de Leone A, Tamayo D, Fiori G. et al. Same-day 2-L PEG-citrate-simethicone plus bisacodyl vs split 4-L PEG: Bowel cleansing for late-morning colonoscopy. World J Gastrointest Endosc 2013; 5: 433-439
    CrossrefPubMedSearch in Google Scholar
  • 23 Aronchick CA, Lipshutz WH, Wright SH. et al. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda. Gastrointest Endosc 2000; 52: 346-352
    CrossrefPubMedSearch in Google Scholar
  • 24 Ferlay J, Soerjomataram I, Dikshit R. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359-E386
    CrossrefPubMedSearch in Google Scholar
  • 25 Zeng H, Zheng R, Guo Y. et al. Cancer survival in China, 2003–2005: a population-based study. Int J Cancer 2015; 136: 1921-1930
    CrossrefPubMedSearch in Google Scholar
  • 26 Manes G, Fontana P, de Nucci G. et al. Colon cleansing for colonoscopy in patients with ulcerative colitis: efficacy and acceptability of a 2-L PEG plus bisacodyl versus 4-L PEG. Inflamm Bowel Dis 2015; 21: 2137-2144
    CrossrefPubMedSearch in Google Scholar
  • 27 Ajani S, Hurt RT, Teeters DA. et al. Ischaemic colitis associated with oral contraceptive and bisacodyl use. BMJ Case Rep 2012; 2012: bcr1220115451
    PubMedSearch in Google Scholar
  • 28 Park SS, Sinn DH, Kim YH. et al. Efficacy and tolerability of split-dose magnesium citrate: low-volume (2 liters) polyethylene glycol vs. single- or split-dose polyethylene glycol bowel preparation for morning colonoscopy. Am J Gastroenterol 2010; 105: 1319-1326
    CrossrefPubMedSearch in Google Scholar
  • 29 Oliva S, Cucchiara S, Spada C. et al. Small bowel cleansing for capsule endoscopy in paediatric patients: a prospective randomized single-blind study. Dig Liver Dis 2014; 46: 51-55
    CrossrefPubMedSearch in Google Scholar
  • 30 Cheng CL, Kuo YL, Liu NJ. et al. Impact of bowel preparation with low-volume (2-liter) and intermediate-volume (3-liter) polyethylene glycol on colonoscopy quality: a prospective observational study. Digestion 2015; 92: 156-164
    CrossrefPubMedSearch in Google Scholar
  • 31 Martel M, Barkun AN, Menard C. et al. Split-dose preparations are superior to day-before bowel cleansing regimens: a meta-analysis. Gastroenterology 2015; 149: 79-88
    CrossrefPubMedSearch in Google Scholar
  • 32 Rex DK, Petrini JL, Baron TH. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2006; 63: S16-S28
    CrossrefPubMedSearch in Google Scholar
  • 33 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
    CrossrefPubMedSearch in Google Scholar
  • 34 Barclay RL, Vicari JJ, Doughty AS. et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. NEJM 2006; 355: 2533-2541
    CrossrefPubMedSearch in Google Scholar