Clin Endosc.  2015 May;48(3):234-238. 10.5946/ce.2015.48.3.234.

A Single-Center Randomized Controlled Trial Evaluating Timing of Preparation for Capsule Enteroscopy

• Black KR
• Truss W
• Joiner CI
• Peter S
• Weber FH

• KMID: 2148572
• DOI: http://doi.org/10.5946/ce.2015.48.3.234

Abstract

BACKGROUND/AIMS
Intestinal lavage (IL) administration immediately before capsule enteroscopy (CE) is superior to lavage the day before the procedure. We aimed to determine the effect of IL timing on CE diagnostic yield.
METHODS
Patients referred for CE were randomized prospectively into two equal groups according to the timing of IL with 2 L of polyethylene glycol solution. Group A and B underwent IL over 2 hours beginning 14 and 4 hours, respectively, before the scheduled CE. The primary outcome measure was preparation quality, measured with a predetermined validated grading scale.
RESULTS
A total of 34 patients were randomized. The frequency of mucosal abnormalities (77% vs. 82%, p=not significant [NS]) and diagnostic yield (47% vs. 53%, p=NS) were similar between the two groups. Moreover, no significant association between the quality of small bowel preparation and the timing at which the purgative for IL was administered was observed (overall fluid transparency, p=0.936; overall mucosal invisibility, p=0.091).
CONCLUSIONS
Day-before IL is equivalent to same-day IL in terms of overall preparation quality, proportion of complete studies to cecum, small bowel transit time, frequency of identified mucosal abnormalities, and overall diagnostic yield.

Keyword

Capsule enteroscopy; Bowel preparation

MeSH Terms

Cecum
Humans
Outcome Assessment (Health Care)
Polyethylene Glycols
Prospective Studies
Therapeutic Irrigation
Polyethylene Glycols

Figure

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  Fig. 1 Fluid transparency assessment by segment and overall grade.

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  Fig. 2 Mucosal invisibility assessment by segment and overall grade.

Reference

1. Iddan G, Meron G, Glukhovsky A, Swain P. Wireless capsule endoscopy. Nature. 2000; 405:417. PMID: 10839527.

2. de Franchis R, Avgerinos A, Barkin J, Cave D, Filoche B. ICCE. ICCE consensus for bowel preparation and prokinetics. Endoscopy. 2005; 37:1040–1045. PMID: 16189787.

3. Mergener K, Ponchon T, Gralnek I, et al. Literature review and recommendations for clinical application of small-bowel capsule endoscopy, based on a panel discussion by international experts. Consensus statements for small-bowel capsule endoscopy, 2006/2007. Endoscopy. 2007; 39:895–909. PMID: 17968807.

4. Dai N, Gubler C, Hengstler P, Meyenberger C, Bauerfeind P. Improved capsule endoscopy after bowel preparation. Gastrointest Endosc. 2005; 61:28–31. PMID: 15672052.

5. Viazis N, Sgouros S, Papaxoinis K, et al. Bowel preparation increases the diagnostic yield of capsule endoscopy: a prospective, randomized, controlled study. Gastrointest Endosc. 2004; 60:534–538. PMID: 15472674.

6. Kantianis A, Karagiannis S, Liatsos C, et al. Comparison of two schemes of small bowel preparation for capsule endoscopy with polyethylene glycol: a prospective, randomized single-blind study. Eur J Gastroenterol Hepatol. 2009; 21:1140–1144. PMID: 19757514.

7. Kilgore TW, Abdinoor AA, Szary NM, et al. Bowel preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials. Gastrointest Endosc. 2011; 73:1240–1245. PMID: 21628016.

8. Esaki M, Matsumoto T, Kudo T, Yanaru-Fujisawa R, Nakamura S, Iida M. Bowel preparations for capsule endoscopy: a comparison between simethicone and magnesium citrate. Gastrointest Endosc. 2009; 69:94–101. PMID: 18710720.

9. Saurin JC, Delvaux M, Gaudin JL, et al. Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push-enteroscopy. Endoscopy. 2003; 35:576–584. PMID: 12822092.

10. Niv Y, Niv G, Wiser K, Demarco DC. Capsule endoscopy: comparison of two strategies of bowel preparation. Aliment Pharmacol Ther. 2005; 22:957–962. PMID: 16268970.

11. 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. PMID: 19098872.

12. 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. PMID: 18072052.

13. Belsey J, Crosta C, Epstein O, et al. Meta-analysis: efficacy of small bowel preparation for small bowel video capsule endoscopy. Curr Med Res Opin. 2012; 28:1883–1890. PMID: 23136911.

14. Koulaouzidis A, Rondonotti E, Karargyris A. Small-bowel capsule endoscopy: a ten-point contemporary review. World J Gastroenterol. 2013; 19:3726–3746. PMID: 23840112.

15. Koornstra JJ. Bowel preparation before small bowel capsule endoscopy: what is the optimal approach. Eur J Gastroenterol Hepatol. 2009; 21:1107–1109. PMID: 19465857.

16. Song HJ, Moon JS, Do JH, et al. Guidelines for bowel preparation before video capsule endoscopy. Clin Endosc. 2013; 46:147–154. PMID: 23614124.

17. Rey JF, Repici A, Kuznetsov K, Boyko V, Aabakken L. Optimal preparation for small bowel examinations with video capsule endoscopy. Dig Liver Dis. 2009; 41:486–493. PMID: 19158002.

18. Fang YH, Chen CX, Zhang BL. Effect of small bowel preparation with simethicone on capsule endoscopy. J Zhejiang Univ Sci B. 2009; 10:46–51. PMID: 19198022.

19. Shiotani A, Opekun AR, Graham DY. Visualization of the small intestine using capsule endoscopy in healthy subjects. Dig Dis Sci. 2007; 52:1019–1025. PMID: 17380402.

20. Wei W, Ge ZZ, Lu H, Gao YJ, Hu YB, Xiao SD. Purgative bowel cleansing combined with simethicone improves capsule endoscopy imaging. Am J Gastroenterol. 2008; 103:77–82. PMID: 18005366.

21. Postgate A, Tekkis P, Patterson N, Fitzpatrick A, Bassett P, Fraser C. Are bowel purgatives and prokinetics useful for small-bowel capsule endoscopy? A prospective randomized controlled study. Gastrointest Endosc. 2009; 69:1120–1128. PMID: 19152909.

22. Almeida N, Figueiredo P, Freire P, et al. The effect of metoclopramide in capsule enteroscopy. Dig Dis Sci. 2010; 55:153–157. PMID: 19184428.

23. Caddy GR, Moran L, Chong AK, Miller AM, Taylor AC, Desmond PV. The effect of erythromycin on video capsule endoscopy intestinal-transit time. Gastrointest Endosc. 2006; 63:262–266. PMID: 16427932.

24. Franke A, Hummel F, Knebel P, et al. Prospective evaluation of small bowel preparation with bisacodyl and sodium phosphate for capsule endoscopy. World J Gastroenterol. 2008; 14:2061–2064. PMID: 18395907.

25. Hooks SB 3rd, Rutland TJ, Di Palma JA. Lubiprostone neither decreases gastric and small-bowel transit time nor improves visualization of small bowel for capsule endoscopy: a double-blind, placebo-controlled study. Gastrointest Endosc. 2009; 70:942–946. PMID: 19577749.

26. Wei W, Ge ZZ, Lu H, Gao YJ, Hu YB, Xiao SD. Effect of mosapride on gastrointestinal transit time and diagnostic yield of capsule endoscopy. J Gastroenterol Hepatol. 2007; 22:1605–1608. PMID: 17683491.

27. Apostolopoulos P, Kalantzis C, Gralnek IM, Liatsos C, Tsironis C, Kalantzis N. Clinical trial: effectiveness of chewing-gum in accelerating capsule endoscopy transit time: a prospective randomized, controlled pilot study. Aliment Pharmacol Ther. 2008; 28:405–411. PMID: 18549462.

28. Lai LH, Wong GL, Lau JY, Sung JJ, Leung WK. Initial experience of real-time capsule endoscopy in monitoring progress of the videocapsule through the upper GI tract. Gastrointest Endosc. 2007; 66:1211–1214. PMID: 17945224.

29. Liao Z, Li ZS, Xu C. Reduction of capture rate in the stomach increases the complete examination rate of capsule endoscopy: a prospective randomized controlled trial. Gastrointest Endosc. 2009; 69(3 Pt 1):418–425. PMID: 19231484.

30. 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. PMID: 22553403.