Impact of Simethicone During Bowel Preparation on Colonoscopy Quality: Systematic Review and Meta-analysis of 38 Randomized Controlled Trials
Douglas K. Rex, MD, MASGE, reviewing Cao RR, et al. J Dig Dis 2022 Jan 24.
Many endoscopists utilize simethicone (SIM) in their bowel preparations for colonoscopy. This systematic review and meta-analysis identified 38 randomized controlled trials relevant to SIM impact on colonoscopy quality. The main findings were:
- SIM increased the rate of Boston Bowel Preparation Scale scores ≥6, the cutoff for adequate bowel preparation, with a risk ratio (RR) of 1.13. All 3 segmental scores improved with SIM, but subgroup analyses indicated that SIM doses should be at least 320 mg.
- The adenoma detection rate (ADR) was not different between SIM and non-SIM groups (RR, 1.01), but subgroup analyses indicated an effect for endoscopists with an ADR <31%.
- Including SIM in bowel preparation did not impact cecal intubation rates or withdrawal time.
- Abdominal distension was reduced by 36% with SIM use, but there was no impact on nausea, vomiting, abdominal pain/cramps, anal irritation, headache, or sleep disturbance.
- Willingness to repeat the same bowel preparation was increased with SIM (RR, 1.15).
- There was a clear benefit of SIM in the bowel preparation on foaming and bubbles.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Cao RR, Wang L, Gao C, et al. Effect of oral simethicone on the quality of colonoscopy: a systematic review and meta-analysis of randomized controlled trials. J Dig Dis 2022 Jan 24. (Epub ahead of print) (https://doi.org/10.1111/1751-2980.13084)