The Effect of Using High Dose Simethicone on the Visibility of Upper Gastrointestinal Endoscopy
Keywords:Simethicone, Esophagogastroduodenoscopy, Mucosal visibility
Object: This study aimed to evaluate the efficacy of using 80 mg compare to 240 mg of simethicone
and no medication on the visibility in Esophagogastroduodenoscopy (EGD)
Study Design: A randomized single blinded (physician) control study
Methods: 141 patients were randomized to 3 groups. The control group (groupA) was prepared by
no medication. The experimental groups were prepared by simethicone 80 mg (groupB) and 240 mg
(group C) 15-30 minutes before underwent EGD by single surgeon. Study endoscopist was blinded
to group allocation. Data were collected by using record form for evaluate 1.) mucosal visibility at 4
locations (lower esophagus, upper stomach, antrum, 1st and 2nd part duodenum) by using total
mucosal visibility score (TMVS) 2.) procedure time 3.) volume of fluid flush required to achieve adequate
mucosal view. The data were analyzed by ANOVA test.
Results: 1.) Both simethicone groups (group B and C) had significantly better mean TMVS (TMVS
group A=7.67, group B=5.43, group C=5.43) compared to control group A (p<0.001) but not significantly
different between group B and C (P=0.337) 2.) Both simethicone groups (group B and C) had
significantly shorter procedure time (group A=237.87 seconds, group B=190.02 seconds, group C=
187.67 seconds) compared to control group A (p<0.001) but not significantly different between
group B and C (P=0.620) 3.) Both simethicone groups (group B and C) had significantly less volume of
fluid flush required to achieve adequate mucosal view (group A=82.61ml, group B=27.17ml, group C
=16.33 ml) compared to control group A (p<0.001) but not significantly different between group B and
Conclusions: By using simethicone 80 mg 15-30 minutes before underwent EGD had increased
mucosal visibility, shortened procedure time and less volume of fluid flush required to achieve adequate
mucosal view compared to control group. But increasing dosage of simethicone 240 mg had not
different to 80 mg.
Keywords: Simethicone, Esophagogastroduodenoscopy, Mucosal visibility
วิวัฒน์ 29.พิมพ์ครั้งที่ 1.กรุงเทพมหานคร : กรุงเทพเวชสาร ; 2548. หน้า 60-81.
2. Bertoni G, Gamina C, Conigliaro R, et al. Randomized placebo-controlled trial of oral liquid simethicone
prior to upper gastrointestinal endoscopy. Endoscopy 1992; 24:268-70.
3. Keeratichananont S, Sobhonslidsuk A, Kitiyakara T, et al. The role of liquid simethicone in enhancing
endoscopic visibility prior to esophagogastroduodenoscopy (EGD): A prospective, randomized, double-blinded,
placebo-controlled trial. J Med Assoc Thai 2010; 93(8): 892-7.
4. Fujii T, Lishi H, Tatsuta M, et al. Effectiveness of premedication with pronase for improving visibility during
gastroendoscopy: A randomized controlled trial. Gastrointerest Endosc 1998; 47(5): 382-7.
5. Lee GJ, Park SJ, Kim SJ. Effectiveness of premedication with pronase for visualization of the mucosa during
endoscopy: A randomized controlled trial. Clin Endosc. 2012; 45(2): 161-4.
6. Kim GS, Cho YK, Cha JM. Effect of pronase as mucolytic agent on imaging quality magnifying endoscopy.
World J Gastroenterol. 2015; 21(8): 2483-9.
7. Chang CC, Chen SH, Lin CP, et al. Premedication with pronase or N-acetylcysteine improves visibility during
gastroendoscopy: An endoscopist-blinded, prospective, randomized study. World J Gastroenterol. 2007;
8. Chang WK, Yeh MK, Hsu HC, et al. Efficacy of simethicone and N-acetylcysteine as premedication in improving
visibility during upper endoscopy. J Gastroenterol Hapatol. 2014; 29(4): 769-74.
9. Kwan V, Deviere J. Endoscopy essentials;preparation, sedation, and surveillance.Endoscopy.2008; 40(1):65-70.
10. Hilal-Dandan R, Brunton LL. Goodman and Gilman’s manual of pharmacology and therapeutics. 2nd ed.
New York: McGraw-Hill; 2014. p 818.
11. Ahsan M, Babaei L, Gholamrezaei A, et al. Efficacy of simethicone in preparation prior to upper gastrointes
tinal endoscope. J of Isfahan Medicine School 2011;29(127):95-101.
12. Song M, Kwek AB, Law NM, et al. Efficacy of small-volume simethicone given at least 30 minutes before
gastroscopy. World J Gastrointest Pharmacol Ther 2016; 7(4):572-8.
13. Basford PJ, Brown J, Gadeke L, et al. A randomized controlled trial of pre-procedure simethicone and
N-acetylcysteine to improve mucosal visibility during gastroscopy, Endosc Int Open 2016 Nov;4(11):1197-
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