Background and Aims
Optimal bowel preparation before capsule endoscopy (CE) is currently unknown. In this
multicenter, blinded, randomized controlled trial, we assessed clinical effectiveness
of 2 types of purgative regimen and a control arm of clear fluid only.
Methods
Patients with suspected small intestinal bleeding were randomized into 3 arms: arm
A, clear fluids only for 18 hours before CE and simethicone 200 mg in 150 mL water
immediately before CE; arm B, same as A + 2 L of polyethylene glycol (PEG) 12 hours
before CE; and arm C, same as A + 1 L PEG + sodium ascorbate 3 hours before CE. To
assess diagnostic yield, lesions were classified either as highly relevant (P2) or
less relevant (P0 or P1) lesions. Small-bowel visualization quality (SBVQ) was assessed
using the Brotz score. Patient tolerability was assessed using the visual analog scale
(0-10, with lower scores indicating better tolerability).
Results
Two hundred twenty-nine patients completed the study. The mean age was 58.7 years
(95% confidence interval, 29.3-87.9), and 47.2% were men. There was no significant
difference in diagnosis of P2 lesions in arms A, B, and C (48.7%, 48.0%, and 45.9%,
respectively; P = .94). Overall SBVQ and distal SBVQ were similar across the 3 arms (P = .94 and P = .68, respectively). Patients reported better tolerability in arm A (mean score,
1.5) compared with arms B and C (mean score, 3.5 and 2.6, respectively; P < .001).
Conclusions
The use of a purgative bowel preparation before CE does not improve diagnostic yield
or small-bowel visualization and is associated with lower patient tolerance. (Clinical
trial registration number: ACTRN 12614000883617.)
Abbreviations:
CE (capsule endoscopy), PEG (polyethylene glycol), RCT (randomized controlled trial), SBTT (small-bowel transit time), SBVQ (small-bowel visualization quality), VAS (visual analog scale)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 14, 2022
Accepted:
July 8,
2022
Received:
April 24,
2022
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
Identification
Copyright
© 2022 by the American Society for Gastrointestinal Endoscopy
