title: Efficacy of small-volume simethicone given at least 30 min before gastroscopy.
abstract: OBJECTIVE
  To evaluate the efficacy of 5 mL simethicone solution in decreasing gastric foam if given at least 30 min before gastroscopy.
  
  
  METHODS
  This was a randomized, placebo controlled, endoscopist blinded study performed at Changi General Hospital. Patients were at least 21 years old, had no prior surgical resection of the upper gastrointestinal tract, and scheduled for elective diagnostic gastroscopies. The primary outcome was the total mucosal visibility score (TMVS) which was evaluated using McNally score. The sample size was calculated to be 24 per group (SD 2.4, 80% power,P< 0.05, 2-samplettest).
  
  
  RESULTS
  Fifty-four patients were randomised to receive either simethicone [1 mL liquid simethicone (100 mg) in 5 mL of water] or placebo (5 mL of water) at least 30 min before their gastroscopy. Six accredited consultants conducted the gastroscopy, and the interobserver agreement of scoring TMVS was good with a Kappa statistic of 0.73. The simethicone group had significantly better mean TMVS compared to placebo (5.78 ± SD 1.65vs8.89 ± SD 1.97,P< 0.001). The improvement was statistically significant for the duodenum and the gastric antrum, angularis, body, and fundus. Percent 51.9 of patients in the simethicone group had a TMVS of 4 (no bubbles at all) to 5 (only 1 area with minimal bubbles), while in the placebo group 3.7% of patients had TMVS of 4 or 5. The number needed to treat was 2.1 to avoid a TMVS of 6 and more. The simethicone group also had a significantly shorter procedure time with less volume of additional flushes required during gastroscopy to clear away obscuring gastric foam.
  
  
  CONCLUSIONS
  With a premedication time of at least 30 min, 5 mL simethicone can significantly decrease gastric foam, decrease the volume of additional flushes, and shorten gastroscopy time.
authors.affiliation: Mingjun Song, Andrew Boon Eu Kwek, Ngai Moh Law, Jeannie Peng Lan Ong, Jessica Yi-Lyn Tan, Prem Harichander Thurairajah, Daphne Shih Wen Ang, Tiing Leong Ang, Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore 529889, Singapore.
authors.forename: Mingjun
authors.initials: M
authors.lastname: Song
authors.affiliation: Mingjun Song, Andrew Boon Eu Kwek, Ngai Moh Law, Jeannie Peng Lan Ong, Jessica Yi-Lyn Tan, Prem Harichander Thurairajah, Daphne Shih Wen Ang, Tiing Leong Ang, Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore 529889, Singapore.
authors.forename: Andrew Boon Eu
authors.initials: AB
authors.lastname: Kwek
authors.affiliation: Mingjun Song, Andrew Boon Eu Kwek, Ngai Moh Law, Jeannie Peng Lan Ong, Jessica Yi-Lyn Tan, Prem Harichander Thurairajah, Daphne Shih Wen Ang, Tiing Leong Ang, Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore 529889, Singapore.
authors.forename: Ngai Moh
authors.initials: NM
authors.lastname: Law
authors.affiliation: Mingjun Song, Andrew Boon Eu Kwek, Ngai Moh Law, Jeannie Peng Lan Ong, Jessica Yi-Lyn Tan, Prem Harichander Thurairajah, Daphne Shih Wen Ang, Tiing Leong Ang, Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore 529889, Singapore.
authors.forename: Jeannie Peng Lan
authors.initials: JP
authors.lastname: Ong
authors.affiliation: Mingjun Song, Andrew Boon Eu Kwek, Ngai Moh Law, Jeannie Peng Lan Ong, Jessica Yi-Lyn Tan, Prem Harichander Thurairajah, Daphne Shih Wen Ang, Tiing Leong Ang, Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore 529889, Singapore.
authors.forename: Jessica Yi-Lyn
authors.initials: JY
authors.lastname: Tan
authors.affiliation: Mingjun Song, Andrew Boon Eu Kwek, Ngai Moh Law, Jeannie Peng Lan Ong, Jessica Yi-Lyn Tan, Prem Harichander Thurairajah, Daphne Shih Wen Ang, Tiing Leong Ang, Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore 529889, Singapore.
authors.forename: Prem
authors.initials: P
authors.lastname: Harichander Thurairajah
authors.affiliation: Mingjun Song, Andrew Boon Eu Kwek, Ngai Moh Law, Jeannie Peng Lan Ong, Jessica Yi-Lyn Tan, Prem Harichander Thurairajah, Daphne Shih Wen Ang, Tiing Leong Ang, Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore 529889, Singapore.
authors.forename: Daphne Shih Wen
authors.initials: DS
authors.lastname: Ang
authors.affiliation: Mingjun Song, Andrew Boon Eu Kwek, Ngai Moh Law, Jeannie Peng Lan Ong, Jessica Yi-Lyn Tan, Prem Harichander Thurairajah, Daphne Shih Wen Ang, Tiing Leong Ang, Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore 529889, Singapore.
authors.forename: Tiing Leong
authors.initials: TL
authors.lastname: Ang
keywords: Gastric foam; Gastroscopy; Premedication; Simethicone