1/14 "In defense of Simethicone" - a Tweetorial for #GITwitter, #Gastroenterology - Instead of focusing on why we can't use Simethicone, I'll try to show you why we (endoscopists) should put it in the water, if u haven't, or re-start if you stopped. 
2/14 - When you are doing a colonoscopy, bubbles are your enemy. There are now countless studies showing that adding simethicone improves both colon prep, inspection time, and most improtantly - Adenoma Detection Rate.
3/14 - Now the first mention of using Simethicone in the water bottle that I could find dates to 1995, so not too long ago. Ever since then, many docs, all over the world used it, and believe me when I say, if you forget to add it to the water, you really notice its absence.
4/14 ... fast forward two decades or so, and the GI world was unfortunately hit with the news of the death of several patients, which were linked to inadequate reprocessing of duodenoscopes. This really raised alarms, and led to appropriate re-evaluation of our practices...
5/14 .... ultimately several models of duodenoscopes and their design was blamed, along with inappropriate re-processing technique, but other questions were raised, including one regarding residue of any kind remaining in the channels of endoscopes after use.
6/14 - so despite very weak evidence(limited to crystal deposition at some facilities,& not other), claims of biofilms &culture growth (again at some facilities, and not others), many GI soc published their Guideance statements discouraging use. Basically-everyone running scared.
Even Olympus had to put out a statement recommending not using simethicone. Important to note Olympus itself never said that the company had any issues removing simethicone - it was the "customer reports",
8/14 Some GI Docs (and hospital admins, nurses, techs) believed that Olympus PROHIBITS use of Simethicone(NOT true ) U need to read Page 2 of Official Olympus statement, where they basically say - "It's up to you to determine what's best for your patients."
9/14 Ultimate test: Is there evidence of harm when u stop using Simethicone? Yes there is! This one practice in Brisbane had their ADR dropp by 10% ( 55%->45%) Clear evidence of HARM when not using Simethicone in the wash water.
10/14 Good news is that you can bring your ADR back up, if you re-introduce simethicone into your irrigation water.
11/14 Why do I think Simethicone blamed 4 "infections" (btw NO infections have been ever found), majority of "evidence" is reported from one source - Ofstead&Associates Inc, a company that does seminars on reprocessing (can u smell a conflict of interest?)No verification outside
12/14 ... in addition - Very little evidence of impact of simethicone on endoscope reprocessing effectiveness, & conflicting studies on crystals (or biofilm)(depends on site) - which means it is actual reprocessing practices and NOT simethicone itself. This editorial is good:
13/14 Why do I think you should use it in the irrigation water, rather than biopsy channel? = seamless, No fiddle around with syringes, uninterruped observation of colon walls uninterrupted, shorter procedures= better 4 patients. (& ?Saves money). AND YOU IMPROVE YOUR ADR!
14/14 Summary - Simethicone is good (and should be used in the water) becase:
You need to track your ADR, withdrawal time, (and maybe insertion time) so U know what U are doing, & what things you can improve. Have the courage of your convictions! Do what's best for the patient (& not manufacturer, hospital lawyers, or other nefarious reason). Get Polyps!
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