Use of Simethicone After Capsule Ingestion and Its Impact on Quality of Small Bowel Video Capsule Endoscopy: A Pilot Study

Abstract

2891 Figure 1. Shows comparison in means of variance with 95% confidence interval in SBVQ at proximal, middle, distal and cumulative small bowel within three research arms: control, sham and treatment.Introduction: Small bowel capsule endoscopy is a tool to visualize the small bowel (SB) for things like obscure bleeding. Studies suggest that using Polyethylene glycol (PEG) prep is significantly better compared to clear liquid and overnight fast in terms of small bowel visualization quality (SBVQ). No studies have been done where simethicone is ingested after capsule swallowing.We intend to give patients simethicone 1 hour after capsule ingestion for two consecutive hours and compare results for SBVQ pre-and post-ingestion groups. We hypothesize post capsule simethicone ingestion group will have significant improvement in SBVQ. Methods: Patient in outpatient setting were divided in control, sham and treatment group. Control group followed the standard hospital pre-capsule protocol that included PEG 238 gram the evening prior. Sham included group that received 3ml of simethicone (20mg/0.3ml) 20 minutes prior to swallowing of the capsule. Treatment group contained patients that had simethicone 3ml 20 minutes prior to capsule swallowing and then 3ml after 1 hours and then 1.5 ml after another 1 hour totaling 7.5ml simethicone. Data concerning SBVQ for every patient was evaluated as an individual zone score from 1-3 points, each in proximal, middle and distal SB and then get a cumulative number 1-9 after adding the three zones together. These points were derived using the Boston bowel prep score. Results: We had 5 patients in control, 4 in sham and 6 in treatment group. Proximal SB: The sham group had a statistically significant higher SBVQ compared to control. The SBVQ of treatment group was higher than control though wasn't statistically significant. Middle SB: No difference was seen in SBVQ. Distal SB: SBVQ mean dropped in treatment group but there wasn't any statistically different. Cumulative SB: Score from all three group zones when added together showed no difference in SBVQ between the three research arms (figure 1). Conclusion: There was no statistically significant difference in the SBVQ when looking at the cumulative score of the entire small bowel. However, there was statistically significant improvement in SBVQ at the proximal segment of SB between sham and the control group suggesting simethicone may be helpful in increasing visualization early on in the SB and not so much as capsule reaches more distally. This is only a pilot project and results may vary when the power of our study increases.