Improved US visualization of the pancreatic tail with simethicone, water, and patient rotation

PURPOSE: To evaluate the effect of degassed water, simethicone, and patient rotation on ultrasonographic (US) visualization of the pancreatic tail. MATERIALS AND METHODS: Seventy patients in whom visualization of the pancreatic tail was poor at US were reevaluated in the upright position after ingesting 2 cups (500 mL) of water with 80 mg of simethicone followed by rotating three times on the examination table. In a few patients, the right posterior oblique position was used. Pancreatic tail visualization and disbursement of gastric gas were evaluated. Seventy patients who received 500 mL of distilled water only served as control subjects. RESULTS: Pancreatic tail visualization in patients versus control subjects was complete in 55 (79%) versus five (7%) of 70 patients and control subjects, partial in 10 (14%) versus 38 (54%), and not improved in five (7%) versus 27 (39%). The effect on diminishing gastric air was closely correlated with the degree of improved visualization in most patients. All patients tolerated the procedure well, with no side effects. The technique added a mean of 8 versus 5 minutes to the examination in patients versus control subjects. The full acoustic window effect of the simethicone-water mixture lasted approximately 10 minutes. CONCLUSION: The simethicone-water-rotation technique is simple, safe, inexpensive, and effective for improving pancreatic tail visualization in ambulatory patients and is superior to the use of water alone.