What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis

Abstract

Background The rate of adequate cleansing (ACR) and complete examinations (CR) are key quality indicators in capsule colonoscopy (CC) and pan-intestinal capsule endoscopy (PCE). Aims To evaluate the efficacy of bowel preparation protocols regarding ACR and CR. Methods We conducted a systematic review and meta-analysis, search terms regarding colon capsule preparation, publication date from 2006/01, and date of search 2021/12, in six bibliographic databases. Multiple steps of the cleansing protocol were assessed: diet, adjunctive laxatives, purgative solution, use of prokinetic agents, and "booster". The meta-analytical frequency of ACR and CR was estimated, and subgroup analyses performed. Strategies associated with higher ACR and CR were explored using meta-analytical univariable and multivariable regression models. Results Twenty-six observational studies and five RCTs included (n = 4072 patients). The pooled rate of ACR was 72.5% (95% C.I. 67.8-77.5%; I 2 = 92.4%), and the pooled rate of CR was 83.0% (95% C.I. 78.7-87.7%; I 2 = 96.5%). The highest ACR were obtained using a low-fibre diet [78.5% (95% C.I. 72.0-85.6%); I 2 = 57.0%], adjunctive laxatives [74.7% (95% C.I. 69.8-80.1%); I 2 = 85.3%], and split dose < 4L polyethylene glycol (PEG) as purgative [77.5% (95% C.I. 68.4-87.8%); I 2 = 47.3%]. The highest CR were observed using routine prokinetics prior to capsule ingestion [84.4% (95% C.I. 79.9-89.2%); I 2 = 89.8%], and sodium phosphate (NaP) as "booster" [86.2% (95% C.I. 82.3-90.2%); I 2 = 86.8%]. In univariable models, adjunctive laxatives were associated with higher ACR [OR 1.81 (95% C.I. 1.13; 2.90); p = 0.014]. CR was higher with routine prokinetics [OR 1.86 (95% C.I. 1.13; 3.05); p = 0.015] and split-dose PEG purgative [OR 2.03 (95% C.I. 1.01; 4.09), p = 0.048]. Conclusions Main quality outcomes (ACR, CR) remain suboptimal for CC and PCE. Despite considerable heterogeneity, our results support low-fibre diet, use of adjunctive sennosides, split dose < 4L PEG, and routine prokinetics, while NaP remains the most consistent option as booster.

Pan-intestinal capsule endoscopy as first-line procedure in patients with suspected mid or lower gastrointestinal bleeding

“…Third, we observed a significant rate of inconclusive PCE, due to poor cleansing and/or incomplete examinations. In a recently published systematic review [17], the overall metaanalytical adequate cleansing rate was 72,5%, and the completion rate was 83%. Sodium phosphate (NaP) is still currently recommended as the preferred booster for capsule colonoscopy and PCE.…”

“…Although security alerts have been issued regarding the use of NaP for bowel cleansing before conventional colonoscopy, its safety profile when used as a booster for the colon capsule (where only half the dose is administered, in two separate doses and with an additional amount of water) has been consistently demonstrated in large series and recently published meta-analyses [17,18]. Also, in a study that evaluated 67 fragile patients at higher risk for complications, namely due to cardiac or This article is protected by copyright.…”

Capsule endoscopy and panendoscopy: A journey to the future of gastrointestinal endoscopy

“…This potentially poses a significant additional burden both to the patient and the healthcare system. A recently published systematic review and meta-analysis[ 9 ] described that key quality outcomes such as adequate cleansing rate (ACR) and complete examination rate (CR) remain sub-optimal for CC or PCE, with an ACR of 72.5% (95%CI 67.8%–77.5%) and a CR of 83.0% (95%CI 78.7%–87.7%). The Leighton-Rex grading scale[ 10 ], and more recently the CC CLEansing Assessment and Report (CC-CLEAR)[ 11 , 12 ], were created to allow a systematic description of the quality of bowel preparation in the colon at capsule endoscopy.…”