scholarly journals Optimal Timing of Simethicone Supplement for Bowel Preparation: A Prospective Randomized Controlled Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Zhen-wen Wu ◽  
Sheng-gang Zhan ◽  
Mei-feng Yang ◽  
Yi-teng Meng ◽  
Feng Xiong ◽  
...  

Background and Aims. Simethicone (SIM), as an antifoaming agent, has been shown to improve bowel preparation during colonoscopy. However, the optimal timing of SIM addition remained undetermined. We aimed to investigate the optimal timing of SIM addition to polyethylene glycol (PEG) to improve bowel preparation. Methods. Eligible patients were randomly assigned to two groups: the SIM evening group (SIM addition to PEG in the evening of the day prior to colonoscopy) and the SIM morning group (SIM addition to PEG in the morning of colonoscopy). The primary outcome was Bubble Scale (BS). The secondary outcomes were Boston Bowel Preparation Scale (BBPS) and adenoma detection rate (ADR). Results. A total of 419 patients were enrolled in this study. The baseline characteristics of the patients were similar in both groups. No significant differences were observed in terms of BS (8.76 ± 0.90 vs. 8.65 ± 1.16, P  = 0.81), ADR (34.1% vs. 30.8%, P  = 0.47), Boston Bowel Preparation Scale (BBPS) (8.59 ± 0.94 vs. 8.45 ± 1.00, P  = 0.15), and withdrawal time (8.22 ± 2.04 vs. 8.01 ± 2.51, P  = 0.094) between the two groups. Moreover, safety and compliance were similar in both groups. However, the SIM evening group was associated with shorter cecal intubation time (3.80 ± 1.81 vs. 4.42 ± 2.03, P  < 0.001), higher BS (2.95 ± 0.26 vs. 2.88 ± 0.38, P  = 0.04) in the right colon, and diminutive ADR (62.5% vs. 38.6%, P  = 0.022) in the right colon, when compared to the SIM evening group. Conclusions. The SIM addition to PEG in the evening of the day prior to colonoscopy can shorten cecal intubation time and improve BS scores and diminutive ADR of the right colon compared with the SIM addition to PEG in the morning of colonoscopy in bowel preparation.

Endoscopy ◽  
2017 ◽  
Vol 50 (04) ◽  
pp. 412-422 ◽  
Author(s):  
Shenghong Zhang ◽  
Danping Zheng ◽  
Jinping Wang ◽  
Jianwei Wu ◽  
Pingguang Lei ◽  
...  

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.


10.20883/183 ◽  
2016 ◽  
Vol 85 (4) ◽  
pp. 298 ◽  
Author(s):  
Elżbieta Poniewierka ◽  
Robert Dudkowiak ◽  
Witold Marczyński

Introduction. Colonoscopy is the gold standard for prevention and early diagnosis of colorectal cancer. Procedure quality is an important issue. Current quality indicators, such as cecal intubation rate, adenoma detection rate, and withdrawal time, are important, but cecum intubation time influences all of them. Factors that determine cecal intubation time (CIT) include body mass index (BMI), age, sex, history of abdominal surgery, quality of bowel preparation, and visceral adipose tissue. Among those who perform colonoscopy, it is believed that the procedure is easier to perform in obese people. Aim. To determine whether cecal intubation time depends on body mass index and sex of patients undergoing colonoscopy.Material and Methods. An analysis of the technical aspects of colonoscopy, such as the time required to intubate the cecum, with respect to BMI and sex in 100 patients.Results. The average time taken to reach the cecum or ileum was slightly longer in obese people than in people with normal weight. Average CIT was almost one minute longer in men than women. Average CIT in obese men was slightly longer than in normal weight men. There was no difference in average CIT in obese and normal weight women. The differences were not statistically significant.Conclusions. This study demonstrates that the claim that endoscopic examination of the lower gastrointestinal tract is easier to perform in obese people cannot be objectively confirmed.


2013 ◽  
Vol 108 ◽  
pp. S186
Author(s):  
Shailendra Singh ◽  
Elie Aoun ◽  
Vishal Goyal ◽  
Mayuri Gupta ◽  
Trupti Shinde ◽  
...  

2016 ◽  
Vol 85 (4) ◽  
pp. 298-301
Author(s):  
Elżbieta Poniewierka ◽  
Robert Dudkowiak ◽  
Witold Marczyński

Introduction. Colonoscopy is the gold standard for prevention and early diagnosis of colorectal cancer. Procedure quality is an important issue. Current quality indicators, such as cecal intubation rate, adenoma detection rate, and withdrawal time, are important, but cecum intubation time influences all of them. Factors that determine cecal intubation time (CIT) include body mass index (BMI), age, sex, history of abdominal surgery, quality of bowel preparation, and visceral adipose tissue. Among those who perform colonoscopy, it is believed that the procedure is easier to perform in obese people. Aim. To determine whether cecal intubation time depends on body mass index and sex of patients undergoing colonoscopy.Material and Methods. An analysis of the technical aspects of colonoscopy, such as the time required to intubate the cecum, with respect to BMI and sex in 100 patients.Results. The average time taken to reach the cecum or ileum was slightly longer in obese people than in people with normal weight. Average CIT was almost one minute longer in men than women. Average CIT in obese men was slightly longer than in normal weight men. There was no difference in average CIT in obese and normal weight women. The differences were not statistically significant.Conclusions. This study demonstrates that the claim that endoscopic examination of the lower gastrointestinal tract is easier to perform in obese people cannot be objectively confirmed.


2021 ◽  
Author(s):  
Subin G Chirayath ◽  
Janak Bahirwani ◽  
Parampreet Kaur ◽  
Noel Martins ◽  
Ronak Modi

Background and Aims: Coronavirus Disease 2019 (COVID-19) has affected many facets of the practice of medicine including screening colonoscopies. Our study looks to observe if there has been an effect on the quality of colonoscopies, as indicated by quality measures such as cecal intubation rate (CIR), cecal intubation time (CIT), scope withdrawal time (SWT) and adenoma detection rate (ADR) with the adoption of standard COVID-19 precautions. Methods: We conducted a retrospective chart review to analyze the effects of the COVID-19 pandemic on screening colonoscopies. The study utilized data on CIR, CIT, SWT and ADR from outpatient, non-emergent procedures conducted at 3 endoscopy suites of St Lukes University Health Network. All inpatient and emergent procedures were excluded. Data was obtained by performing chart review on EPIC electronic health record. Results: Our study demonstrated that the total number of screening colonoscopies was decreased between 2019 to 2020 (318 in 2019 vs 157 in 2020, p= 0.005). CIT (320+/-105 seconds in 2019 vs 392+/-107 seconds in 2020, p=0.001) and SWT (706+/-232 seconds in 2019 vs 830+/-241 seconds in 2020, p=0.001) were increased while CIR (98.2% in 2019 vs 96.6% in 2020, p=0.04) was decreased between 2019 and 2020 likely due to PPE introduction. ADR was similar between the two groups (38.23 (12.50-66.66) in 2019 vs 38.18(16.66-66.00) in 2020, p=0.8). Conclusion: Our study showed that quality indices for screening colonoscopies like cecal intubation rate, cecal intubation time and scope withdrawal time were negatively impacted during the initial COVID time period compared to pre-COVID time. The study also displayed that though there was a significant decline in both screening and diagnostic colonoscopies during pandemic, adenoma detection rates were comparable. Thus, the efficiency of the procedures was affected by the use of PPE but it did not affect the colonoscopies clinical benefits.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Keshu Shan ◽  
Hongpeng Lu ◽  
Zhixin Zhang ◽  
Jiarong Xie ◽  
Lu Xu ◽  
...  

Abstract Objectives Colorectal cancer on the right side of the colon has been suggested to be harder to detect by colonoscopy. The aim of this study was to evaluate whether a second forward-view examination of the right side of the colon could increase the adenoma detection rate (ADR) and/or polyp detection rate (PDR). Methods This was a single-centre randomized controlled trial. Patients undergoing colonoscopy were recruited and randomly assigned to the second forward-view examination (SFE) group, in which the right side of the colon was examined twice or the traditional colonoscopy (TC) group in which the colonoscopy was performed in a standard manner. The primary outcome was the ADR of right colon. The overall PDR and ADR, PDR of the right colon, per-adenoma miss rate of the right colon, and advanced lesion detection rate were also recorded and compared. Results A total of 392 patients were included in the study (SFE group 197 vs. TC group 195). The ADR and PDR of the right colon in the SFE group were significantly higher than those in the TC group (ADR 10.7% vs. 5.1%; P = 0.042); PDR 17.8% vs. 9.7%, P = 0.021). No significant difference was found in overall PDR/ADR, or advanced lesion detection rate between the two groups. Conclusions This prospective controlled study revealed that a second forward-view examination could modestly increase the ADR and PDR of the right colon during unsedated colonoscopies. This simple, safe and time-effective technique might be recommended for routine unsedated colonoscopy. Trial registration: Clinical Trials.gov, NCT03619122. Registered on 7/8/2018.


Medicine ◽  
2018 ◽  
Vol 97 (35) ◽  
pp. e12113 ◽  
Author(s):  
Gee Young Yun ◽  
Hyuk Soo Eun ◽  
Ju Seok Kim ◽  
Jong Seok Joo ◽  
Sun Hyung Kang ◽  
...  

2019 ◽  
Vol 07 (02) ◽  
pp. E225-E231
Author(s):  
Shajan Peter ◽  
Nipun Reddy ◽  
Mohammed Naseemuddin ◽  
Jenine Zaibaq ◽  
Gerald McGwin ◽  
...  

Abstract Background and study aims Colonoscopy can be technically challenging and cause discomfort in patients. The integrated Scope Guide assist is built in to show that with its use outcomes are improved during colonoscopy. We aimed to test the usefulness of the Magnetic Scope Guide Assist (ScopeGuide) with respect to cecal intubation time, and other procedural quality outcomes. Patients and methods We conducted a prospective study of outpatients undergoing elective colonoscopy at the endoscopic units of the University of Alabama at Birmingham (UAB) from March 2016 to July 2016. Patients were randomly assigned in a 1:1 block design to groups that either had standard colonoscopy or Scope-guided colonoscopy. The primary outcome measure was cecal intubation time (CIT). Secondary outcome measures included use of manual pressure, position changes for cecal intubation and sedation requirements. Results Three hundred patients were randomized to either group; standard (n = 150) vs. Scope-guided (n = 150). The mean CIT was not statistically different for the standard and the Scope-guided groups (4.6 vs. 4.3 minutes; P = 0.46). There were also no statistical differences in frequency of manual pressure applied (16.7 % for Scope-guided vs. 19.1 % for standard; P = 0.65) or position changes (11.4 % for scope guided vs. 8.8 % standard; P = 0.56). Sedation requirements showed lesser use of midazolam (3.9 mg vs. 4.7 mg, P = 0.003) in the Scope-guide group, while there was no significant difference in use of fentanyl (fentanyl – 62.1 mg vs. 68.9 mg, P = 0.09 similar between groups, for Scope-guided vs. standard groups, respectively). Adverse events were similar in both groups. Conclusions In patients undergoing routine elective colonoscopy, use of ScopeGuide by experienced colonoscopists did not improve CIT or affect the frequency of ancillary maneuvers. The benefit of this device during training of endoscopists could be considered for further studies.


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