LAUSR

preparation, to preparation with only water, and to mucosal cleansingwithwater flushes during endoscopy. The recently published position statement document of the British Society of Gastroenterology and the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland about quality standards in upperGI endoscopy recommended that “adequate mucosal visualisation should be achieved by a combination of adequate air insufflation, aspiration and the use of mucosal cleansing techniques,” which include simethicone and N-acetylcysteine or Pronase. In consideration of the concerns about simethicone, an alternative would be to use a mucolytic agent (Pronase, Millipore Sigma, Burlington, Mass; or N-acetylcysteine) alone. Although no evidence is available about a difference in lesion detection, the mucosal visibility obtained with simethicone was superior to that obtained with Pronase or N-acetylcysteine in a meta-analysis. For colonoscopy, simethicone given with bowel preparation seems to reduce the amount of bubbles, although with no evidence of superior cleansing, the implications of the bubble reduction are unclear. The European Society of Gastrointestinal Endoscopy does suggest adding simethicone to standard bowel preparation, whereas the American Society for Gastrointestinal Endoscopy leaves it to the discretion of the prescribing physician. Let’s hope that the potential risks of simethicone use during endoscopy do not increase the already significant resistance among Western endoscopists to implementing the premedication drink before upper GI endoscopy. In countries like Chile, where gastric cancer represents a major health problem and activities to improve the endoscopic detection of early stage lesions are being developed, any restraint in the efforts to improve mucosal cleansing could have devastating effects. In summary, we agree that further investigations are needed to understand the effects of simethicone use on the endoscopes, and the possible risks of infection, but this word of caution should not stop us from using all the tools available in achieving an immaculate mucosa during upper GI endoscopy.