Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Mar 31, 2019; 7(3): 110-119
Published online Mar 31, 2019. doi: 10.13105/wjma.v7.i3.110
Higher dose of simethicone decreases colonic bubbles and increases prep tolerance and quality of bowel prep: Meta-analysis of randomized controlled trials
Mohammad F Madhoun, Maham Hayat, Ijlal Akbar Ali
Mohammad F Madhoun, Maham Hayat, Ijlal Akbar Ali, Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma, OK 73105, United States
Mohammad F Madhoun, Maham Hayat, Ijlal Akbar Ali, Veteran Affairs Medical Center, Oklahoma, OK 73105, United States
Author contributions: Madhoun MF acquisition of data, analysis and interpretation of data, drafting the article, final approval; Hayat M acquisition of data, analysis and interpretation of data, drafting the article, final approval; Ali IA interpretation of data, revising the article, final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: Mohammad F Madhoun, MD, MSc, Academic Fellow, Associate Professor, Doctor, Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Andrews Academic Tower, Suite 7426, 800 Stanton L. Young Blvd, Oklahoma, OK 73104, United States. mohammad-madhoun@ouhsc.edu
Telephone: +1-405-2715428
Received: February 22, 2019
Peer-review started: February 22, 2019
First decision: March 5, 2019
Revised: March 21, 2019
Accepted: March 24, 2019
Article in press: March 25, 2019
Published online: March 31, 2019
Processing time: 37 Days and 10.5 Hours
ARTICLE HIGHLIGHTS
Research background

Colon cancer is the second most common cause of cancer related deaths in both men and women across the world. Colonoscopy is an essential tool that can help screen and prevent it. However, inadequate bowel preparation decreases rate of adenoma detection, increases procedure time; decreasing overall quality of colonoscopy. Antifoaming agents, such as simethicone, may help improve adequate preparation if added to bowel preparation. However, data regarding this is unclear. There is also upcoming data that injection of simethicone through the endoscopy channel may be associated with particle deposition and lead to scope reprocessing infection outbreaks.

Research motivation

So far, it is unclear whether simethicone is effective in increasing adenoma detection rates (ADRs) in different bowel preparation and there is no data on what dose should be used in bowel preparation.

Research objectives

To conduct a meta-analysis to help summarize available data for simethicone use during various bowel preparations, confirm the effect on ADR, bowel prep tolerability and investigate an optimal dose.

Research methods

Studies related to this topic were searched for in multiple databases. Only 11 studies met the strict inclusion criteria. Two reviewers independently scored the identified studies for methodology and abstracted pertinent data. Review Manager 5 was used to analyze the data.

Research results

We were able to show that addition of simethicone to bowel preparation lead to a significant decrease in inadequate bowel preparation and number of colonic bubbles. This resulted in a significant increase in the ADR as well. We also noted higher doses of simethicone (approximately 500 mg) were more effective.

Research conclusions

Our study confirms the effectiveness of simethicone use in bowel preparations in helping improve quality of colonoscopies.

Research perspectives

Whilst searching for literature, we realized few meta-analyses have effectively analyzed simethicone effectiveness in different bowel preparations and looked at optimal dosage. More studies are needed to investigate an association of simethicone use with bowel preparation with scope reprocessing infection.