Are bowel purgatives and prokinetics useful for small-bowel capsule endoscopy? A prospective randomized controlled study

Background

Capsule endoscopy (CE) is limited by incomplete small-bowel transit and poor view quality in the distal bowel. Currently, there is no consensus regarding the use of bowel purgatives or prokinetics in CE.

Objective

To evaluate the usefulness of bowel purgatives and prokinetics in small-bowel CE.

Design

Prospective single-blind randomized controlled study.

Setting

Academic endoscopy unit.

Patients

A total of 150 patients prospectively recruited.

Intervention

Patients were randomized to 1 of 4 preparations: “standard” (fluid restriction then nothing by mouth 12 hours before the procedure, water and simethicone at capsule ingestion [S]); “standard” + 10 mg oral metoclopramide before the procedure (M); Citramag + senna bowel-purgative regimen the evening before CE (CS); Citramag + senna + 10 mg metoclopramide before the procedure (CSM).

Main Outcome Measurements

Gastric transit time (GTT) and small-bowel transit time (SBTT), completion rates (CR), view quality, and patient acceptability. Secondary outcome measures: positive findings, diagnostic yield.

Results

No significant difference was noted among groups for GTT (median [minutes] M, CS, and CSM vs S: 17.3, 24.7, and 15.1 minutes vs 16.8 minutes, respectively; P = .62, .18, and .30, respectively), SBTT (median [minutes] M, CS, and CSM vs S: 260, 241, and 201 vs 278, respectively; P = .91, .81, and .32, respectively), or CRs (85%, 85%, and 88% vs 89% for M, CS, and CSM vs S, respectively; P = .74, .74, and 1.00, respectively). There was no significant difference in view quality among groups (of 44: 38, 37, and 40 vs 37 for M, CS, and CSM, vs S, respectively; P = .18, .62, and .12, respectively). Diagnostic yield was similar among the groups. CS and CSM regimens were significantly less convenient (P < .001), and CS was significantly less comfortable (P = .001) than standard preparation.

Conclusions

Bowel purgatives and prokinetics do not improve CRs or view quality at CE, and bowel purgatives reduce patient acceptability.

Abbreviations: CE, capsule endoscopy, CR, completion rate, CS, Citramag and senna bowel purgative, CSM, Citramag, senna plus oral metoclopramide, DBE, double-balloon enteroscopy, GTT, gastric transit time, IQR, interquartile range, M, standard preparation plus oral metoclopramide, OGIB, obscure GI bleeding, PE, push enteroscopy, S, standard bowel preparation, SBTT, small-bowel transit time