title: Simethicone residue remains inside gastrointestinal endoscopes despite reprocessing.
abstract: During a study designed to assess endoscope reprocessing effectiveness, a borescope was used to examine lumens and ports. Cloudy, white, viscous fluid was observed inside fully reprocessed gastroscopes and colonoscopes. This fluid resembled simethicone, which is commonly administered to reduce foam and bubbles that impede visualization during gastrointestinal endoscopy. This article describes methods used to determine whether the observed fluid contained simethicone.
  
  
  
  Photographs of residual fluid were taken using a borescope. Sterile cotton-tipped swabs were used to collect samples of fluid observed in 3 endoscope ports. Samples were evaluated using Fourier transform infrared spectroscopy (FTIR)-attenuated total reflection analysis.
  
  
  
  Residual fluid was observed inside 19 of 20 endoscopes. Fluid photographed in 8 endoscopes resembled simethicone solutions. FTIR analysis confirmed the presence of simethicone in 2 endoscopes.
  
  
  
  Fluid containing simethicone remained inside endoscopes despite reprocessing. Simethicone is an inert, hydrophobic substance that may reduce reprocessing effectiveness. Simethicone solutions commonly contain sugars and thickeners, which may contribute to microbial growth and biofilm development. Studies are needed to assess the prevalence of residual moisture and simethicone in endoscopes and determine the impact on reprocessing effectiveness. We recommend minimizing the use of simethicone pending further research into its safety.
authors: Ofstead & Associates, Inc, Saint Paul, MN. Electronic address: cori@ofsteadinsights.com.
authors: Cori L
authors: CL
authors: Ofstead
authors: Ofstead & Associates, Inc, Saint Paul, MN.
authors: Harry P
authors: HP
authors: Wetzler
authors: Ofstead & Associates, Inc, Saint Paul, MN.
authors: Ellen A
authors: EA
authors: Johnson
authors: Ofstead & Associates, Inc, Saint Paul, MN.
authors: Otis L
authors: OL
authors: Heymann
authors: Division of Gastroenterology, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.
authors: Thomas J
authors: TJ
authors: Maust
authors: Division of Gastroenterology, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.
authors: Michael J
authors: MJ
authors: Shaw
mesh_terms: D000934:Antifoaming Agents / Q000032:analysis*; D003666:Decontamination / Q000379:methods*; D020776:Endoscopes, Gastrointestinal; D006801:Humans; D012841:Simethicone / Q000032:analysis*; D017550:Spectroscopy, Fourier Transform Infrared
chemical_list: D000934:Antifoaming Agents; D012841:Simethicone
keywords: Endoscope; biofilm; colonoscope; contamination; epidemiology; gastroscope; simethicone