Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2021; 9(10): 2238-2246
Published online Apr 6, 2021. doi: 10.12998/wjcc.v9.i10.2238
Impact of simethicone on bowel cleansing during colonoscopy in Chinese patients
Hu Zhang, Jing Liu, Song-Lin Ma, Man-Lin Huang, Yan Fan, Min Song, Jing Yang, Xiao-Xia Zhang, Qi-Long Song, Jing Gong, Ping-Xiao Huang, Heng Zhang
Hu Zhang, Jing Liu, Song-Lin Ma, Man-Lin Huang, Yan Fan, Min Song, Jing Yang, Xiao-Xia Zhang, Qi-Long Song, Jing Gong, Ping-Xiao Huang, Heng Zhang, Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
Hu Zhang, Department of Gastroenterology, The Eighth Hospital of Wuhan, Wuhan 430014, Hubei Province, China
Author contributions: Zhang H designed this study and critically revised the manuscript; Zhang H, Liu J, and Ma SL were responsible for data acquisition and extraction; Zhang H drafted the manuscript, analyzed the data, and interpreted the results; Huang ML, Fan Y, Song M, Zhang XX, Song QL, Gong J, Yang J, and Huang PX were involved in editing the manuscript; all authors read and approved the final manuscript to be published.
Supported by Natural Science Foundation of Wuhan, No. WX18Y04.
Institutional review board statement: The study was approved by the medical ethics committee of The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology Institutional (Approval No. 2019-9).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All of the authors declare that they have no conflicts of interest regarding this paper.
Data sharing statement: Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Heng Zhang, MA, MD, Chief Doctor, Professor, Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Road, Jiang'an District, Wuhan 430014, Hubei Province, China. 497697662@qq.com
Received: December 17, 2020
Peer-review started: December 17, 2020
First decision: January 6, 2021
Revised: January 13, 2021
Accepted: January 26, 2021
Article in press: January 26, 2021
Published online: April 6, 2021
Processing time: 102 Days and 20.4 Hours
Abstract
BACKGROUND

Four-liter polyethylene glycol (PEG) solutions are effective for bowel cleansing, but their large volume might hinder patient compliance. Due to the unique features of Asians, 4 L PEG might be a suboptimal bowel preparation in predominantly ethnically Asian countries. In view of this, a balance should be achieved between the volume and effectiveness. The ideal bowel cleansing regimen for a colonoscopy has yet to be determined in a Chinese population.

AIM

To compare the cleansing efficacy of 3 L PEG plus simethicone with 4 L PEG.

METHODS

A total of 291 patients were randomly allocated to two groups: Group 1 (n = 145) received 4 L split-dose PEG (4-P); group 2 (n = 146) received 3 L split-dose PEG plus simethicone (3-PS). Bowel-cleansing efficacy was evaluated by endoscopists using the Boston bowel preparation scale (BBPS) and the bubbles score.

RESULTS

Although there were no significant differences in the total BBPS score or the adequate rate of bowel preparation between the two groups, the BBPS score of the right-side colon was significantly higher in the 3-SP group (2.37 ± 0.54 vs 2.21 ± 0.78; P = 0.04). Moreover, the use of simethicone significantly reduced bubbles in all colon segments (P < 0.001). The mean withdrawal time was significantly shorter in the 3-PS group (8.8 ± 3.4 vs 9.6 ± 2.3; P = 0.02). Furthermore, significantly more proximal adenomas were detected in the 3-PS group (53.6% vs 45.7%; P = 0.03). In addition, the proportions of patients with nausea and bloating were significantly lower in the 3-SP group (P < 0.01 for both). More patients in the 3-PS group expressed willingness to repeat the bowel preparation (87.7% vs 76.6%, P = 0.01).

CONCLUSION

Three-liter PEG shows satisfactory bowel cleansing despite the decrease in dosage, and addition of simethicone with better bubble elimination and enhanced patient acceptance offers excellent potential impact on the detection of proximal adenomas in Chinese patients.

Keywords: Polyethylene glycol; Simethicone; Colonoscopy; Bowel preparation; Cleansing efficacy

Core Tip: The incidence and mortality of colorectal cancer have been rapidly increasing in China over the last decade. A high-quality bowel preparation is a key determinant of the efficacy of colonoscopy to reduce the incidence of colorectal cancer, but 4 L polyethylene glycol might be a suboptimal bowel preparation in the Chinese population. In view of a balance between the volume and effectiveness, this study showed that 3 L polyethylene glycol had satisfactory bowel cleansing, and addition of simethicone with better bubble elimination and enhanced patient acceptance offered excellent potential impact on the detection of proximal adenomas in Chinese patients.