Single-Dose Linaclotide Is Equal in Efficacy to Polyethylene Glycol for Bowel Preparation Prior to Capsule Endoscopy

Abstract

Background: Video capsule endoscopy provides noninvasive visualization of the small bowel, but yield is often limited by debris. At our institution, preparation with polyethylene glycol (PEG) and simethicone is used to improve visualization. Aims: We hypothesized that linaclotide and simethicone would yield equal to better results. Methods: We enrolled 29 subjects for the experimental regimen of linaclotide and simethicone. We maintained standard NPO status, clear liquid period, and simethicone dose. Subjects received 290 μg of linaclotide 1 h prior to capsule. We randomly selected 30 historical PEG controls. Two blinded gastroenterologists graded visualization as ideal/excellent, good, fair, or poor and measured small bowel transit time. Results: Thirteen men and 16 women were enrolled with an average age of 61. There was no significant difference in exam quality between linaclotide and control. Preparation was rated as ideal/excellent or good in 19 of 28 of linaclotide and 18 of 28 PEG subjects when recorder entered the small bowel (p = 0.78, chi-square). Median small bowel transit was 192 min (linaclotide) versus 202 min (PEG), respectively (p = 0.93, t test). Three studies (1 linaclotide and 2 PEG) failed to leave the stomach; 1 linaclotide subject had recorder failure. Diagnostic yield was similar (18/29 for linaclotide and 16/30 for PEG, p = 0.50, chi-square). There were no serious side effects. No differences in age, sex, BMI, or frequency of diabetes, GERD, or gastroparesis were measured between the groups. Conclusions: Single-dose linaclotide 1 h before capsule endoscopy was equally effective when compared to PEG in terms of visualization and transit time. This trial was registered at ClincialTrials.gov, number NCT02465385.

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

“…Small bowel transit after ingesting 290 µg of Linaclotide (a guanylatcyclase-receptor agonist) 1 h prior to SBCE in 29 patients was similar to a historic group of 30 patients with standard PEG prep (192 min versus 202 min, respectively; p = 0.93) [ 60 ]. Furthermore, the proportion of patients with good or excellent image quality was similar (19/28 for linaclotide, and 18/28 for PEG).…”

Comparison of the Positive Rate and Diagnostic Value of Capsule Endoscopy and Double-Balloon Enteroscopy in Small Bowel Disease: A Retrospective Cohort Analysis

“…So, there may be blind areas and omissions during the image shooting; 11 in addition, the cleanliness of the lumen will affect the image. 12 Most capsule endoscopes are able to photograph the ileocecal valve or colon within the working time, that is, complete the examination of the entire small intestine; however, 10% ~ 20% of the capsule could not reach the ileocecal valve before the battery is depleted due to various reasons. In our study, the completion rate of CE was 86.9%, which was similar to that reported in the literature.…”

Polyethylene glycol combined with linaclotide is an effective and well-tolerated bowel preparation regimen for colonoscopy: an endoscopist-blinded, randomized, controlled trial

“…First, all patients were placed on a restricted diet the day before colonoscopy. This was limited in fruits, vegetables and meats, while eggs, milk, noodles, porridge and other low-residue foods were allowed [12,[18][19][20]. Patients in the 2 L PEG group were instructed to consume a PEG solution 6 h before colonoscopy [21].…”