Screening colonoscopy requires adequate mucosal visualization and is essential for the prevention of colorectal cancer. The presence of bubbles can often preclude colonic visualization, necessitating the use of simethicone (SIM) through the colonoscope. Formation of biofilm from the introduction of intraprocedure SIM use has been linked to multi-drug resistant micro-organism contamination that cannot always be eliminated by standard endoscope disinfecting and reprocessing techniques. Current studies on the use of SIM in conjunction with colon preparation agents are limited, with conflicting results.