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BACKGROUND: Colonoscopy plays a vital role in screening and detecting colorectal cancer as well as various other gastrointestinal (GI) conditions. With current standard bowel preparation, bubbles tend to line the mucosa in approximately one third of patients and potentially obscure clear visualization. Simethicone, an over the counter, anti-foaming agent, has been used in GI departments as an irrigating fluid with some success in an effort to reduce bubbles. However, simethicone has been found to be contributing to the formation of a biofilm inside the irrigation channel of the endoscope potentially resulting in scope infection and contributing to transmission of microorganisms. METHODS: A prospective randomized controlled trial was designed to investigate the addition of oral simethicone to bowel preparation on the formation of bubbles during colonoscopy and its impact on visualization. RESULTS: The results of our study demonstrate a clear improvement in mucosal visibility due to the addition of oral simethicone to bowel preparation leading to a significant reduction in bubbles throughout the entire colon. CONCLUSION: Increased visibility during colonoscopies may result in better endoscopy results and a longer endoscope life.