swedish learning 21; seattle; swedish
Purpose: To evaluate a safe alternative to simethicone, that aligns with the scope manufacturer recommendations, and eliminates GI bubbles to improve provider visualization.
Hypothesis: GI Ease will improve bubble scale scores to improve visualization of the GI tract and facilitate polyp detection.
Background: Multiple independent studies have shown that simethicone, even when highly diluted, remains in the endoscope working channel after all manual cleaning and reprocessing protocols have been followed correctly. Although simethicone effectively eliminates gas bubbles, it carries unacceptable risks. It is insoluble in water and alcohol, challenging to remove, and may foster biofilm build-up and microbial proliferation. Due to these infection risks, and potential damage to scopes from over brushing, all endoscope manufacturers have recommended against simethicone use. GI Ease is a water-based, anti-gas product that is water-soluble and does not contain sugars, thickeners, or binding agents. It may be an alternative which improves visualization, without carrying the infection risks that simethicone poses.
Method: After receiving IRB approval, we used a prospective, quasi-experimental design with 100 subjects. Sixty-four mL of GI Ease was diluted in 1000 mL of sterile water. During the endoscopy procedure, we flushed GI Ease through the biopsy channel. Each flush was 50-60 mL. Using the bubble scale scoring system, ranging from 3 (bubbles filling the entire lumen) to 0 (no or minimal bubbles), a score was determined by the endoscopist.
Results: A bubble score was assigned before and after GI Ease was used. The number of flushes needed depended upon bubbles identified in the GI tract. In 99/100 participants, the bubble scale score was improved to 0-1, facilitating GI visualization. Our pre-post paired t-test of bubble scores showed significant bubble decline (t=27, p<.00001). Multiple regression, using bubble score change as the dependent outcome, showed number of flushes to be significant (adjusted R2=.155, p<.001) with no age or sex differences.
Conclusions: GI Ease, a water-soluble solution, reduced GI gas bubbles and improved visualization. Manual cleaning of the endoscope post procedure was completed, with no variation of ATP test results. Results may cause endoscopy practice changes and the discontinuation of simethicone use, reducing the risk of infection and aligning with gastroenterology governing body and scope manufacturer recommendations.
Mallard, Teri; Roswell, Sandra; and Ramakrishnan, Amarnath, "Water-Soluble Alternative to Simethicone to Safely Visualize GI-Tract. Have We Found Our White Whale?" (2022). All Podium Presentations. 5.