Evaluating a combined bowel preparation for small-bowel capsule endoscopy: a prospective randomized–controlled study

Abstract

Background Capsule endoscopy (CE) is frequently hindered by intra-luminal debris. Our aim was to determine whether a combination bowel preparation would improve small-bowel visualization, diagnostic yield, and the completion rate of CE. Methods Single-blind, prospective randomized–controlled study of outpatients scheduled for CE. Bowel-preparation subjects ingested 2 L of polyethylene glycol solution the night prior to CE, 5 mL simethicone and 5 mg metoclopramide 20 minutes prior to CE and laid in the right lateral position 30 minutes after swallowing CE. Controls had no solid food after 7 p.m. the night prior to CE and no liquids 4 hours prior to CE. Participants completed a satisfaction survey. Capsule readers completed a small-bowel-visualization assessment. Results Fifty patients were prospectively enrolled (56% female) with a median age of 54.4 years and 44 completed the study (23 patients in the control group and 21 in the preparation group). There was no significant difference between groups on quartile-based small-bowel visualization (all P > 0.05). There was no significant difference between groups in diagnostic yield (P = 0.69), mean gastric (P = 0.10) or small-bowel transit time (P = 0.89). The small-bowel completion rate was significantly higher in the preparation group (100% vs 78%; P = 0.02). Bowel-preparation subjects reported significantly more discomfort than controls (62% vs 17%; P = 0.01). Conclusions Combined bowel preparation did not improve small-bowel visualization but did significantly increase patient discomfort. The CE completion rate improved in the preparation group but the diagnostic yield was unaffected. Based on our findings, a bowel preparation prior to CE does not appear to improve CE performance and results in decreased patient satisfaction (ClinicalTrials.gov, No. NCT01243736).

Evaluation by a Machine Learning System of Two Preparations for Small Bowel Capsule Endoscopy: The BUBS (Burst Unpleasant Bubbles with Simethicone) Study

“…This may be due to a lack of power related to the small sample size in our study. Still, up to now, studies based on human analysis remain controversial regarding any SB cleanliness improvement with simethicone [ 5 , 7 , 29 ]. In a recent randomized trial, a preparation with a high dose of simethicone did not significantly improve the SB cleanliness compared to a standard preparation, as assessed by human readers [ 30 ].…”

“…These factors have different causes and different protocols try to improve them. There are international guidelines on SB CE preparation, but the ideal preparation is not yet established (liquid diet, low residue diet, polyethylene glycol (PEG)-based purge, use of prokinetics, use of anti-foaming agents and timing) [ 2 , 3 , 4 , 5 , 6 , 7 ].…”

Lavage, Simethicone, and Prokinetics—What to Swallow with a Video Capsule

“…In a prospective study 44 patients were randomized to no prep (only NPO 12 h before SBCE) or standard prep with 2 L of Moviprep (PEG and ascorbic acid) the night before and 5 mg of liquid metoclopramide 20 min before ingestion of the capsule. There was a higher completion rate with PillCam SB2 in the prep group, but no difference in mucosa visualization or diagnostic yield, while patient discomfort, mainly related to PEG, was higher in the prep group (62% vs. 17%, p < 0.01) [ 63 ].…”

Preparation for capsule endoscopy, what recommendations are there?

“…La preparación óptima para la cápsula es controvertida [1][2] . Una preparación insuficiente compromete la precisión diagnóstica e incrementa el coste y las molestias del paciente 2,3 .…”

“…De ellos, cuatro metaanálisis concluyen que el polietilenglicol mejora la visualización 1,2 . Según esto, la sociedad europea de endoscopia digestiva ESGE recomienda modificaciones dietéticas e ingesta de 2 litros de polietilenglicol y antiespumantes, mientras que no recomienda la administración rutinaria de procinéticos [1][2][3][4] . Sin embargo, reconoce que no hay datos concluyentes sobre la tasa de exploraciones finalizadas, el rendimiento diagnóstico y la dosis y el momento óptimo para la ingesta de purgantes [1][2][3][4] .…”