The efficacy and safety of simethicone for gastrointestinal preparation prior to pediatric endoscopy: a systematic review and meta-analysis.

To evaluate the bubble-eliminating efficacy and safety of simethicone when used for gastrointestinal preparation before pediatric endoscopy. We conducted a comprehensive Literature search from inception to April 5, 2025, in PubMed, Embase, Web of Science, Cochrane library, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese VIP Information Database, and Wan Fang Med Database. For the quantitative analysis, mean difference (MD) was used to assess continuous outcomes and risk ratio for dichotomous outcomes. Methodological quality of included studies was assessed using the Cochrane risk of bias tool. Statistical analyses were performed using RevMan 5.3 and Stata 13 software. Nine studies involving 2188 pediatric patients were included (simethicone group, 1102; no-simethicone group, 1086). Compared to the no-simethicone group, the simethicone group demonstrated significant advantages in multiple outcomes: superior endoscopic visual clarity [RR = 1.34, 95% CI, (1.15, 1.56); z = 3.71, P = 0.0002]; fewer endoscopic flushing events [RR = 0.23, 95%CI, (0.07, 0.77); z = 2.39, P = 0.02]; shorter procedure time [WMD =  - 35.86, 95% CI, (- 69.34, - 2.37); z = 2.10, P = 0.04]. However, no statistically significant difference was observed in adverse events (nausea and vomiting [RR = 1.00, 95% CI, (0.84, 1.18); z = 0.04, P = 0.97]; abdominal distension [RR = 0.76, 95% CI, (0.40, 1.42); z = 0.87, P = 0.38]; abdominal pain [RR = 1.11, 95% CI, (0.75, 1.65); z = 0.54, P = 0.59]); acceptability [RR = 1.48, 95% CI, (0.19, 11.84); z = 0.37, P = 0.71]; compliance [RR = 0.98, 95% CI, (0.77, 1.26); z = 0.13, P = 0.90]; and diagnostic yield [RR = 1.07, 95% CI, (0.92, 1.25); z = 0.91, P = 0.36]. The risk of bias was low with a moderate grade of certainty. Conclusions: Simethicone used before pediatric endoscopy enhanced visualization clarity during gastroscopy and colonoscopy, reduced the number of endoscopic flushing and operative time without increasing postprocedural adverse events, but do not effect diagnostic yield during enteroscopy, medication acceptability, and compliance.