Castor Oil in Bowel Preparation Regimens for Colon Capsule Endoscopy: A Systematic Review with Meta-Analysis

Abstract

Completing colon capsule endoscopy (CCE) investigations rely on successful transit and acceptable bowel preparation quality. We investigated the effect of adding castor oil to the CCE bowel preparation regimen on the completion rate using a meta-analysis of existing literature. We conducted a systematic literature search in PubMed, Web of Science, and Embase. Included studies underwent quality assessment, and data for meta-analysis were extracted. Pooled estimates for excretion rate and acceptable bowel preparation rate were calculated. We identified 72 studies matching our search criteria, and six were included in the meta-analysis. Three of the studies had control groups, although two used historical cohorts. The pooled excretion rate (92%) was significantly higher in patients who received castor oil than in those who did not (73%). No significant difference in acceptable colonic cleanliness was observed. Castor oil has been used in a few studies as a booster for CCE. This meta-analysis shows the potential for this medication to improve excretion rates, and castor oil could be actively considered in conjunction with other emerging laxative regimens in CCE. Still, prospective randomized trials with appropriate control groups should be conducted before any conclusions can be drawn. Prospero ID: CRD42022338939.

Effect of chewing gum in bowel preparation for patients undergoing small bowel and colon capsule endoscopy: Systematic review with meta-analysis

“…This has resulted in numerous studies searching for the optimal composition of the bowel preparation regimen to increase acceptable bowel cleanliness and excretion rates 3 . In addition, add-on boosters such as castor oil, prucalopride, and a sulfate-based solution have influenced completion rates, suggesting that they have potential 26 27 28 .…”

Advances in colon capsule endoscopy: a review of current applications and challenges

“…More recently, a combination of lower volume PEG preparations, NaP free boosters and prokinetics are being utilized with good success, reducing the volume of fluid patients have to ingest without compromising polyp detection (26,58). Prucalopride, a serotonin receptor antagonist that accelerates colonic transit time, and castor oil, a vegetable oil from the castor bean, have recently been shown to significantly improve CCE completion and polyp detection rates (59)(60)(61)(62)(63). There is widespread variation in preparation protocols used in clinical practice and a need for large, prospective studies comparing these protocols (51).…”