Suboptimal mucosal visibility during oesophagogastroduodenoscopy (OGD) is a well-recognised contributor to missed upper GI lesions and has been repeatedly highlighted in quality-assurance literature, including the PEUGIC study, which recommends pre-procedure simethicone to improve detection. In our unit, visibility was frequently impaired by bubbles and foam, and the recent introduction of new endoscope models rendered the mucolytic water pump incompatible. A baseline audit across eight OGD lists revealed 0% pre-procedure simethicone use. This created an urgent need for a simple, cost-effective, and equipment-independent solution to restore mucosal clarity.

We introduced a standardised SOP incorporating oral Infacol (simethicone) administered 30 minutes pre-procedure as a low-cost alternative mucolytic strategy. Unlike pump-delivered simethicone, this method requires no equipment modifications and is compatible with all endoscope systems. The SOP was rolled out across ten OGD lists over four weeks. Infacol was administered by admitting nurses, and visibility was assessed using a 4-point Mucosal Visibility Index (MVI). Feedback was collected from consultants, registrars, nurse endoscopists, and nursing staff to evaluate feasibility, workflow impact, and perceived improvement in clarity. Patient eligibility, contraindications, and practical barriers were also assessed.

Improvement in visibility and workflow:

-Consultants: 80% reported improved visibility; 1 equivocal.

-Registrars: 99% reported better visibility.

-Nurse endoscopists/room nurses: 99% noted less flushing and smoother workflow.

-Admitting nurses: 90% found administration easy; one PEG patient unsuitable.

Operational impact:

-Clear reduction in intra-procedure flushing.

-Faster progression through OGD due to fewer visibility interruptions.

-Intervention simple, quick, and well-tolerated.

-No adverse effects observed.

Staff engagement:

-Strong multidisciplinary buy-in.

-Common themes: improved visibility, greater diagnostic confidence, time-saving, and easy integration into routine practice.

Pre-procedure Infacol is a low-cost, practical, and highly effective intervention to improve mucosal visibility during OGD. It significantly reduced the need for flushing, improved procedural flow, and was easily integrated into existing endoscopy pathways with excellent staff acceptance. This innovation provides an immediate solution for centres where traditional mucolytic pumps cannot be used and aligns with PEUGIC study recommendations to enhance diagnostic quality. The project supports wider implementation of standardised pre-procedure mucosal preparation across endoscopy services.