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Evaluating a combined bowel preparation for small-bowel capsule endoscopy: a prospective randomized-controlled study.

ABSTRACT: Background:Capsule endoscopy (CE) is frequently hindered by intra-luminal debris. Our aim was to determine whether a combination bowel preparation would improve small-bowel visualization, diagnostic yield, and the completion rate of CE. Methods:Single-blind, prospective randomized-controlled study of outpatients scheduled for CE. Bowel-preparation subjects ingested 2?L of polyethylene glycol solution the night prior to CE, 5?mL simethicone and 5?mg metoclopramide 20?minutes prior to CE and laid in the right lateral position 30?minutes after swallowing CE. Controls had no solid food after 7 p.m. the night prior to CE and no liquids 4?hours prior to CE. Participants completed a satisfaction survey. Capsule readers completed a small-bowel-visualization assessment. Results:Fifty patients were prospectively enrolled (56% female) with a median age of 54.4?years and 44 completed the study (23 patients in the control group and 21 in the preparation group). There was no significant difference between groups on quartile-based small-bowel visualization (all P?>?0.05). There was no significant difference between groups in diagnostic yield (P?=?0.69), mean gastric (P?=?0.10) or small-bowel transit time (P?=?0.89). The small-bowel completion rate was significantly higher in the preparation group (100% vs 78%; P?=?0.02). Bowel-preparation subjects reported significantly more discomfort than controls (62% vs 17%; P?=?0.01). Conclusions:Combined bowel preparation did not improve small-bowel visualization but did significantly increase patient discomfort. The CE completion rate improved in the preparation group but the diagnostic yield was unaffected. Based on our findings, a bowel preparation prior to CE does not appear to improve CE performance and results in decreased patient satisfaction (ClinicalTrials.gov, No. NCT01243736).

SUBMITTER: Hansel SL

PROVIDER: S-EPMC7217271 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Evaluating a combined bowel preparation for small-bowel capsule endoscopy: a prospective randomized-controlled study.

Hansel Stephanie L SL Murray Joseph A JA Alexander Jeffrey A JA Bruining David H DH Larson Mark V MV Mangan Thomas F TF Dierkhising Ross A RA Almazar Ann E AE Rajan Elizabeth E

Gastroenterology report 20191019 1

<h4>Background</h4>Capsule endoscopy (CE) is frequently hindered by intra-luminal debris. Our aim was to determine whether a combination bowel preparation would improve small-bowel visualization, diagnostic yield, and the completion rate of CE.<h4>Methods</h4>Single-blind, prospective randomized-controlled study of outpatients scheduled for CE. Bowel-preparation subjects ingested 2 L of polyethylene glycol solution the night prior to CE, 5 mL simethicone and 5 mg metoclopramide 20 minutes prior ...[more]

PMID: 32419949

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Project description:To assess the cleansing efficacy and safety of a new Colon capsule endoscopy (CCE) bowel preparation regimen.This was a multicenter, prospective, randomized, controlled study comparing two CCE regimens. Subjects were asymptomatic and average risk for colorectal cancer. The second generation CCE system (PillCam® COLON 2; Medtronic, Yoqneam, Israel) was utilized. Preparation regimens differed in the 1st and 2nd boosts with the Study regimen using oral sulfate solution (89 mL) with diatrizoate meglumine and diatrizoate sodium solution ("diatrizoate solution") (boost 1 = 60 mL, boost 2 = 30 mL) and the Control regimen oral sulfate solution (89 mL) alone. The primary outcome was overall and segmental colon cleansing. Secondary outcomes included safety, polyp detection, colonic transit, CCE completion and capsule excretion ? 12 h.Both regimens had similar cleansing efficacy for the whole colon (Adequate: Study = 75.9%, Control = 77.3%; P = 0.88) and individual segments. In the Study group, CCE completion was superior (Study = 90.9%, Control = 76.9%; P = 0.048) and colonic transit was more often < 40 min (Study = 21.8%, Control = 4%; P = 0.0073). More Study regimen subjects experienced adverse events (Study = 19.4%, Control = 3.4%; P = 0.0061), and this difference did not appear related to diatrizoate solution. Adverse events were primarily gastrointestinal in nature and no serious adverse events related either to the bowel preparation regimen or the capsule were observed. There was a trend toward higher polyp detection with the Study regimen, but this did not achieve statistical significance for any size category. Mean transit time through the entire gastrointestinal tract, from ingestion to excretion, was shorter with the Study regimen while mean colonic transit times were similar for both study groups.A CCE bowel preparation regimen using oral sulfate solution and diatrizoate solution as a boost agent is effective, safe, and achieved superior CCE completion.

Dataset Information

Evaluating a combined bowel preparation for small-bowel capsule endoscopy: a prospective randomized-controlled study.

Publications

Evaluating a combined bowel preparation for small-bowel capsule endoscopy: a prospective randomized-controlled study.

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