A novel purgative protocol for capsule endoscopy of the small bowel produces better quality of visibility than 2 l of PEG: Timing is of the essence

Abstract

Introduction: The ideal way of preparing patients for small-bowel capsule endoscopy has been controversial. Previous studies have shown that ingestion of 2 l of polyethylenglycol (PEG) 12 hours prior to capsule ingestion leads to improved visibility in comparison to no preparation at all. We speculated that using a post-ingestion (PI), booster-based cleansing protocol might provide an alternative to the PEG cleansing protocol. Methods: This randomized, blinded, prospective study enrolled 45 individuals. Patients were allocated to either of two groups. The PEG group ingested 2 l PEG 12 hours prior to the exam (n ¼ 22) and the PI group ingested one sachet of Picolax Õ dissolved in 250 ml of water one hour after swallowing the capsule with 500 ml of water (n ¼ 18). Primary endpoints were overall small bowel and distal third of small bowel cleansing levels. Secondary endpoints were average gastric and small-bowel transit time. Results: Forty-five patients participated in this study. Five individuals were excluded because of incomplete study. Percentage of patients with adequate visibility in the distal third of the small bowel in the PEG group was 9% vs 72% in the PI group (p < 0.0001). Average gastric time and total transit time were shorter in the PI group vs the PEG group (p ¼ 0.0065). Conclusion: Timing of ingestion of the PicolaxÕ purgative 60 minutes after swallowing the capsule endoscopy delivers better visibility in the distal third of the small bowel than the accepted cleansing protocol of ingesting 2 l PEG 12 hours prior to the capsule endoscopy procedure.

Small Bowel Transit Time in Capsule Endoscopy: a determinant factor for the diagnosis of small bowel bleeding

“…8 Adler et al presented conflicting results regarding the use of small bowel preparation, and using a post-ingestion purge-based cleansing protocol (Picolax®) found a better visibility of the small bowel, however with a shorter SBTT. 17 On the contrary, in our study and in accordance to a previous study of our center, the administration of bowel preparation (PEG 1L) did not shorten the SBTT, having no influence on diagnostic yield. 18 Additionally, several authors reported that inpatient status is inversely correlated with completion rate of SBCE mainly because hospitalized patients represent a population with reduced mobility and overall health.…”

Changes in performance of small bowel capsule endoscopy based on nationwide data from a Korean Capsule Endoscopy Registry

“…The time interval from the ingestion of the bowel preparation regimen to performing CE can be delayed because performing colonoscopy and clinician's decision-making to perform CE after colonoscopy can take time. This time delay may adversely affect bowel preparation quality [20,21], because debris and intestinal fluid can affect preparation of the distal small bowel [22].…”

KODA score: an updated and validated bowel preparation scale for patients undergoing small bowel capsule endoscopy

“…The primary strength of the KODA score beyond reliability is simplicity and ease of use. Prior attempts at measuring small bowel cleanliness either relied on manual review of the entire capsule video or required specialized imaging software beyond that routinely available in clinical practice 7 15 24 26 27 28 29 30 31 32 33 34 . Given that the former may require in excess of 1 hour to review a single capsule video for bowel preparation quality and the latter requires extraction of high-quality screen captures for further image processing using specialized software more commonly used by graphic designers, neither are feasible options for most clinicians.…”