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Simethicone residue remains inside gastrointestinal endoscopes despite reprocessing

Published:August 03, 2016DOI:https://doi.org/10.1016/j.ajic.2016.05.016

      Highlights

      • Flexible endoscopes had residual fluid after reprocessing and drying.
      • Fluid resembled simethicone used to reduce foam and bubbles.
      • Photographs and laboratory analysis found that the fluid contained simethicone.
      • Residual fluid containing simethicone may impact reprocessing effectiveness.

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.

      Key Words

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