Optimal Approach for Small Bowel Capsule Endoscopy Using Polyethylene Glycol and Metoclopramide with the Assistance of a Real-Time Viewer

Abstract

Aim: Capsule endoscopy is limited by the poor image quality of the distal bowel and incomplete small bowel transit. The aim of this study was to establish an optimal medication protocol for capsule endoscopy performed using a real-time viewer. Methods: A total of 80 patients were prospectively recruited. The patients were randomized into two groups: the ‘conventional group’ (without any preparation) and the ‘real-time group’ (in which a real-time viewer was attached). At 60 min after swallowing the capsule, if the capsule hadreached the small bowel, 500 ml of polyethylene glycol was administered; if the capsule was still located in the stomach, 10 mg of metoclopramide was given intramuscularly, followed by 500 ml of polyethylene glycol solution. Results: The completion rate was significantly higher in the real-time group as compared with that in the conventional group (72.5 vs. 90.0%). Our protocol yielded a significantly improved image quality of the distal small bowel [image quality score = 1.6 vs. 3.0 (max 4.0)]. The detection rate of lesions in the distal small bowel was higher in the real-time group than in the conventional group. Conclusions: The present study clearly showed that our protocol yielded an improved completion rate and also improved image quality.

Lubiprostone improves visualization of small bowel for capsule endoscopy: a double-blind, placebo-controlled 2-way crossover study

“…It has been reported that use of prokinetics such as metoclopramide 23 25 , erythromycin 14 and mosapride 32 may decrease randomness in the rate of gastric emptying and reduce SBTT. Selby 23 reported that administration of oral metoclopramide before capsule administration reduced GTT with no effect on SBTT, but still had a positive effect by increasing the percentage of capsules reaching the cecum.…”

“…Quality assessment of the capsule endoscopic images was made in accordance with the scale used by Aymer et al, with some modification 17 23 24 25 . We used a 5-point scale (0 – 4) based on the percentage of the capsule images that were unimpaired by presence of debris or dark luminal fluid (4, 100 – 80 %; 3, 80 – 60 %; 2, 60 – 40 %; 1, 40 – 20 %; 0, 20 – 0 %).…”

Evaluation of visualized area percentage assessment of cleansing score and computed assessment of cleansing score for capsule endoscopy

“…[4671116172223242526] The disadvantages of using the AAC are that the results are influenced by the quality of the samples when using interval sampling, and that calculation of the visualized area is time-consuming and influenced by human variability. The advantages of using the CAC are that it can evaluate a single image or a number of images in any part of the small intestine [Figures 3 and 4], it is less time-consuming, and the results are not influenced by human variability.…”

Small Bowel Capsule Endoscopy

“…Most studies have looked into preparation taken the day before ingestion of the capsule, and only a handful have looked into taking the bowel preparation soon after ingestion [10][11][12]. Ito et al used a regimen where, in addition to a 12-h fast and simethicone taken at the time of capsule ingestion, the intervention group drank a small volume of 500 ml of PEG solution 30 min to 2 h after ingestion of the capsule [10].…”