Small Bowel Capsule Endoscopy within 6 Hours Following Bowel Preparation with Polyethylene Glycol Shows Improved Small Bowel Visibility

Abstract

Although bowel preparation influences small bowel visibility for small bowel capsule endoscopy (SBCE), the optimal timing for bowel preparation has not been established yet. Thus, the aim of the study was to evaluate the optimal timing of polyethylene glycol (PEG) for small bowel preparation before SBCE. This multicenter prospective observational study was conducted on patients who underwent SBCE following bowel preparation with polyethylene glycol (PEG). Patients were categorized into three groups according to the time used for completing PEG ingestion: group A, within 6 h; group B, 6–12 h; and group C, over 12 h. The percentage of unclean segment in small bowel (unclean image duration / small bowel transit time × 100) and small bowel visibility quality (SBVQ) were evaluated according to the time interval between the last ingestion of PEG and swallowing of small bowel capsule endoscope. A total of 90 patients were enrolled and categorized into group A (n = 40), group B (n = 27), and group C (n = 23). The percentage of unclean segment in the entire small bowel increased gradually from group A to C (6.6 ± 7.6% in group A, 11.3 ± 11.8% in group B, and 16.2 ± 10.7% in group C, p = 0.001), especially in the distal small bowel (11.4 ± 13.6% in group A, 20.7 ± 18.7% in group B, and 29.5 ± 16.4% in group C, p < 0.001). The proportion of patients with adequate SBVQ in group A was significantly (p < 0.001) higher (30/40, 75.0%) than that in group B (17/27, 63.0%) or group C (5/23, 21.7%). In multivariate analysis, group A was associated with an increased likelihood of adequate SBVQ compared with group C (odds ratio [OR]: 13.05; 95% confidence interval [CI]: 3.53–48.30, p < 0.001). Completing PEG ingestion within 6 h prior to SBCE could enhance small bowel visibility.

Optimal Bowel Preparation Method to Visualize the Distal Ileum via Small Bowel Capsule Endoscopy

“…Therefore, we consider that the shorter time required for the preparation in Group C (2 h) than that required in Group B (at least 4 h) might have worked as effectively for the visibility of the distal ileum rather than the direct effect of colonoscopy. Although the optimal timing for bowel preparation has not yet been established, Choi CW et al recommended that faster bowel preparation should be performed (within 6 h before SBCE) for improved distal small bowel examination [6]. Our results are considered to be consistent with this report.…”

“…Second, this study did not examine the finding rates. A recent paper reported that there was no significant difference in finding rates between different timing of laxative intake, but there was a significant difference in visibility, especially in the distal small bowel [6]. Even if there was no significant difference in finding rates in our study, we believe it was useful.…”

“…Another possible reason is the difference in preparation timing. Several studies have shown that taking purgative solutions just before SBCE is useful [4][5][6]20]. Moreover, because taking purgative solutions after the confirmation of the reach of the capsule to the small bowel is useful [21,22], the shorter time required for the preparation in Group C (2 h) than that required in Group B (at least 4 h) might have worked as effectively for the visibility of the distal ileum.…”

“…Esaki et al reported the effectivity of receiving 0.9 L of magnesium citrate (MC) 3 h before the examination [5]. Additionally, in the recent report by Choi CW et al, the timing of bowel preparation within 6 h between the last ingestion of PEG and swallowing of SBCE improved the quality of small bowel visibility [6]. However, the efficacy of bowel preparation prior to SBCE remains controversial.…”

Sennoside A+B Is as Effective as Polyethylene Glycol in Preparation for Small Intestine Capsule Endoscopy

“…Blurred intestinal fluid, air bubbles, and food particles may impair the visibility of the small intestine and decrease the diagnostic yield. 2 Nevertheless, the optimal bowel cleaning regimen has not been defined yet in the literature. Generally, overnight fasting (at least 12 hours) and clear fluid ingestion only are recommended.…”