Clin Endosc.  2020 Nov;53(6):713-718. 10.5946/ce.2019.213.

The Efficacy of 4 Liters of Clear Liquids for Small Bowel Preparation Prior to Video Capsule Endoscopy

• Placone N
• Bahar R
• Mann S

• KMID: 2511231
• DOI: http://doi.org/10.5946/ce.2019.213

Abstract

Background/Aims
Optimal small bowel (SB) preparation for video capsule endoscopy (VCE) is controversial. Our study aimed to support the use of a specified volume of 4 liters of clear liquids for bowel preparation for VCE.
Methods
A retrospective review of 284 patients who underwent SB preparation with 2 liters of polyethylene glycol (PEG) and 284 patients who had 4 liters of clear liquid preparation. We analyzed image quality, endoscopic findings, completion rate, and transit times.
Results
The 4-liter clear liquid group had significantly higher mean image quality scores when compared to the PEG group (2.908±0.77 to 2.669±0.64, p<0.0001), as well as more studies with adequate preparation (72% to 64%, p=0.0214). Although the PEG group had more endoscopic findings on VCE (40% to 23%, p<0.0001), there was a significant difference in the indications for the procedure between the groups. There was no difference in the capsule completion rate or SB transit time.
Conclusions
Our data demonstrate significantly higher mean image quality scores when using a specified volume of 4 liters of clear liquid compared to 2 liters of PEG. This study supports the growing evidence of the effectiveness of a 4-liter clear liquid SB preparation as opposed to PEG for VCE.

Keyword

Clear liquids; Polyethylene glycol; Small bowel preparation; Video capsule endoscopy

Reference

1. Iddan G, Meron G, Glukhovsky A, Swain P. Wireless capsule endoscopy. Nature. 2000; 405:417.

2. Ladas SD, Triantafyllou K, Spada C, et al. European Society of Gastrointestinal Endoscopy (ESGE): recommendations (2009) on clinical use of video capsule endoscopy to investigate small-bowel, esophageal and colonic diseases. Endoscopy. 2010; 42:220–227.

3. Koulaouzidis A, Rondonotti E, Karargyris A. Small-bowel capsule endoscopy: a ten-point contemporary review. World J Gastroenterol. 2013; 19:3726–3746.

4. Hookey L, Louw J, Wiepjes M, et al. Lack of benefit of active preparation compared with a clear fluid-only diet in small-bowel visualization for video capsule endoscopy: results of a randomized, blinded, controlled trial. Gastrointest Endosc. 2017; 85:187–193.

5. Ninomiya K, Yao K, Matsui T, et al. Effectiveness of magnesium citrate as preparation for capsule endoscopy: a randomized, prospective, open-label, inter-group trial. Digestion. 2012; 86:27–33.

6. Hong-Bin C, Yue H, Chun H, Shu-Ping X, Yue Z, Xiao-Lin L. Randomized controlled trial of cholestyramine and hydrotalcite to eliminate bile for capsule endoscopy. Saudi J Gastroenterol. 2016; 22:122–126.

7. Stein DJ, Copland A, McDaniel D, Hays RA. Single-dose linaclotide is equal in efficacy to polyethylene glycol for bowel preparation prior to capsule endoscopy. Dig Dis. 2019; 37:297–302.

8. Kim ES, Chun HJ, Keum B, et al. Coffee enema for preparation for small bowel video capsule endoscopy: a pilot study. Clin Nutr Res. 2014; 3:134–141.

9. Niv E, Ovadia B, Ron Y, et al. Ensure preparation and capsule endoscopy: a two-center prospective study. World J Gastroenterol. 2013; 19:1264–1270.

10. Chen HB, Huang Y, Chen SY, et al. Small bowel preparations for capsule endoscopy with mannitol and simethicone: a prospective, randomized, clinical trial. J Clin Gastroenterol. 2011; 45:337–341.

11. Wu S, Gao YJ, Ge ZZ. Optimal use of polyethylene glycol for preparation of small bowel video capsule endoscopy: a network meta-analysis. Curr Med Res Opin. 2017; 33:1149–1154.

12. Kotwal VS, Attar BM, Gupta S, Agarwal R. Should bowel preparation, antifoaming agents, or prokinetics be used before video capsule endoscopy? A systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2014; 26:137–145.

13. Ito T, Ohata K, Ono A, et al. Prospective controlled study on the effects of polyethylene glycol in capsule endoscopy. World J Gastroenterol. 2012; 18:1789–1792.

14. Rokkas T, Papaxoinis K, Triantafyllou K, Pistiolas D, Ladas SD. Does purgative preparation influence the diagnostic yield of small bowel video capsule endoscopy?: a meta-analysis. Am J Gastroenterol. 2009; 104:219–227.

15. Mathus-Vliegen E, Pellisé M, Heresbach D, et al. Consensus guidelines for the use of bowel preparation prior to colonic diagnostic procedures: colonoscopy and small bowel video capsule endoscopy. Curr Med Res Opin. 2013; 29:931–945.

16. Song HJ, Moon JS, Do JH, et al. Guidelines for bowel preparation before video capsule endoscopy. Clin Endosc. 2013; 46:147–154.

17. Yung DE, Rondonotti E, Sykes C, Pennazio M, Plevris JN, Koulaouzidis A. Systematic review and meta-analysis: is bowel preparation still necessary in small bowel capsule endoscopy? Expert Rev Gastroenterol Hepatol. 2017; 11:979–993.

18. Gkolfakis P, Tziatzios G, Dimitriadis GD, Triantafyllou K. Meta-analysis of randomized controlled trials challenging the usefulness of purgative preparation before small-bowel video capsule endoscopy. Endoscopy. 2018; 50:671–683.

19. Catalano C, Companioni RA, Khankhanian P, et al. Video capsule endoscopy: is bowel preparation necessary? J Investig Med. 2016; 64:1114–1117.

20. Enns RA, Hookey L, Armstrong D, et al. Clinical practice guidelines for the use of video capsule endoscopy. Gastroenterology. 2017; 152:497–514.

21. Pons Beltrán V, González Suárez B, González Asanza C, et al. Evaluation of different bowel preparations for small bowel capsule endoscopy: a prospective, randomized, controlled study. Dig Dis Sci. 2011; 56:2900–2905.

22. Bahar R, Gupta A, Mann SK. Clear liquids versus polyethylene glycol preparation for video capsule endoscopy of the small bowel: a randomized controlled trial. Digestion. 2019; 99:213–218.

23. Yazici C, Losurdo J, Brown MD, et al. Inpatient capsule endoscopy leads to frequent incomplete small bowel examinations. World J Gastroenterol. 2012; 18:5051–5057.

24. Brotz C, Nandi N, Conn M, et al. A validation study of 3 grading systems to evaluate small-bowel cleansing for wireless capsule endoscopy: a quantitative index, a qualitative evaluation, and an overall adequacy assessment. Gastrointest Endosc. 2009; 69:262–270, 270.e1.

25. van Tuyl SA, den Ouden H, Stolk MF, Kuipers EJ. Optimal preparation for video capsule endoscopy: a prospective, randomized, single-blind study. Endoscopy. 2007; 39:1037–1040.

26. Van Weyenberg SJ, De Leest HT, Mulder CJ. Description of a novel grading system to assess the quality of bowel preparation in video capsule endoscopy. Endoscopy. 2011; 43:406–411.

27. Klein A, Gizbar M, Bourke MJ, Ahlenstiel G. Validated computed cleansing score for video capsule endoscopy. Dig Endosc. 2016; 28:564–569.