Higher dose of simethicone decreases colonic bubbles and increases prep tolerance and quality of bowel prep:Meta-analysis of randomized controlled trials  

作　　者：Mohammad F Madhoun Maham Hayat Ijlal Akbar Ali 

机构地区：[1]Division of Digestive Diseases and Nutrition,University of Oklahoma Health Sciences Center [2]Veteran Affairs Medical Center

出　　处：《World Journal of Meta-Analysis》2019年第3期110-119,共10页世界荟萃分析杂志

摘　　要：BACKGROUND Antifoaming agents,such as simethicone,may facilitate mucosal inspection during colonoscopy.However,conflicting results have been reported with regard to the impact of simethicone on quality of bowel preparation and adenoma detection rate(ADR).AIM To perform a meta-analysis of trials that have compared simethicone vs placebo during colonoscopy.METHODS A reproducible literature search of multiple medical databases yielded eleven studies(n = 2605) for inclusion.Studies were compared for quality of bowel preparation,bubbles quality,ADR,and tolerability.Two reviewers independently scored the identified studies for methodology and abstracted pertinent data.Pooling was conducted by both fixed-effects and random-effects models.Relative risk(RR) estimates with a 95% confidence interval(CI) were calculated.Heterogeneity was assessed by I-squared index(I2) statistics.RESULTS Patients' demographic characteristics were comparable in all studies.Of the 2605 patients,1300 were in the simethicone group,whereas 1305 were in the placebo group.Inadequate bowel preparation was much lower in the simethicone group than in the placebo group [13% vs 24.6%; RR = 0.51(0.31-0.82); P < 0.0001].The placebo group was more likely to have significant colonic bubbles than was the simethicone group [35% vs 8%; RR = 1.49(1.25-1.76); P = 0.0001].Use of simethicone resulted in a slight,statistically significant increase in ADR compared with the placebo group [26.6% vs 21.6%,RR = 1.07(1.01-1.13); P = 0.02].Higher doses of simethicone(> 478 mg) were more likely to result in significant reduction of inadequate bowel preparation,colonic bubbles,and to improve ADR.CONCLUSION Adding simethicone improved the quality of bowel preparation,visualization,tolerability,and,eventually,ADR.BACKGROUND Antifoaming agents,such as simethicone,may facilitate mucosal inspection during colonoscopy.However,conflicting results have been reported with regard to the impact of simethicone on quality of bowel preparation and adenoma detection rate(ADR).AIM To perform a meta-analysis of trials that have compared simethicone vs placebo during colonoscopy.METHODS A reproducible literature search of multiple medical databases yielded eleven studies(n = 2605) for inclusion.Studies were compared for quality of bowel preparation,bubbles quality,ADR,and tolerability.Two reviewers independently scored the identified studies for methodology and abstracted pertinent data.Pooling was conducted by both fixed-effects and random-effects models.Relative risk(RR) estimates with a 95% confidence interval(CI) were calculated.Heterogeneity was assessed by I-squared index(I2) statistics.RESULTS Patients' demographic characteristics were comparable in all studies.Of the 2605 patients,1300 were in the simethicone group,whereas 1305 were in the placebo group.Inadequate bowel preparation was much lower in the simethicone group than in the placebo group [13% vs 24.6%; RR = 0.51(0.31-0.82); P < 0.0001].The placebo group was more likely to have significant colonic bubbles than was the simethicone group [35% vs 8%; RR = 1.49(1.25-1.76); P = 0.0001].Use of simethicone resulted in a slight,statistically significant increase in ADR compared with the placebo group [26.6% vs 21.6%,RR = 1.07(1.01-1.13); P = 0.02].Higher doses of simethicone(> 478 mg) were more likely to result in significant reduction of inadequate bowel preparation,colonic bubbles,and to improve ADR.CONCLUSION Adding simethicone improved the quality of bowel preparation,visualization,tolerability,and,eventually,ADR.

关 键 词：SIMETHICONE Colonoscopy BUBBLES BOWEL preparation ADENOMA detection rate 

分 类 号：R[医药卫生]