Bowel preparation regimens for colon capsule endoscopy: a review

Abstract

Colon capsule endoscopy (CCE) is being actively evaluated as an emerging complementary or alternative procedure for evaluation of the colon. The yield of CCE is significantly dependent on the quality of bowel preparation. In addition to achieving a stool-free colon the bowel preparation protocols need to decrease bubble effect and aid propulsion of the capsule. An extensive English literature search was done using PubMed with search terms of colon capsule endoscopy, PillCam and bowel preparation. Full-length articles which met the criteria were included for review. A total of 12 studies including 1149 patients were reviewed. There was significant variability in the type of bowel preparation regimens. Large-volume (3-4 liters) polyethylene glycol (PEG) was the most widely used laxative. Lower volumes of PEG showed comparable results but larger studies are needed to determine efficacy. Sodium phosphate was used as an effective booster in most studies. Magnesium citrate and ascorbic acid are emerging as promising boosters to replace sodium phosphate when it is contraindicated. The potential benefit of prokinetics needs further evaluation. Over the past decade there has been significant improvement in the bowel preparation regimens for CCE. Further experience and studies are likely to standardize the bowel preparation regimens before CCE is adopted into routine clinical practice.

Polyethylene glycol plus an oral sulfate solution as a bowel cleansing regimen for colon capsule endoscopy: a prospective, single-arm study in healthy volunteers

“…Several studies have been conducted to optimize the bowel preparation regimen prior to CCE [Spada et al 2011a[Spada et al , 2011bSinghal et al 2014]. While most studies use a high volume (3-4 liters) of PEG as the primary laxative, the incorporation of prokinetics and booster agents varies and includes combinations of sodium phosphate, magnesium citrate, bisacodyl, Gastrografin and Senna [Singhal et al 2014;Spada et al 2015].…”

“…Adequate bowel cleansing is critical prior to both traditional colonoscopy and CCE [Johnson et al 2014;Rex, 2014aRex, , 2014bSinghal et al 2014] and is often considered by patients the most disagreeable aspect of the procedure .…”

“…Thus, use of a booster agent during the capsule procedure is required to ensure that the capsule reaches the anal verge before the end of its battery life [Spada et al 2012;Singhal et al 2014]. Booster agents have included sodium phosphate, magnesium citrate, bisacodyl and polyethylene glycol (PEG) [Singhal et al 2014]. …”

“…Thus, many studies have been conducted to optimize the bowel preparation regimen in both colonoscopy and CCE [Spada et al 2011;Mathus-Vliegen et al 2013;Rex, 2014aRex, , 2014bSinghal et al 2014].…”

Is capsule colonoscopy the solution for incomplete conventional colonoscopy?

“…In a Japanese study, gastrographin appears to be useful and safe as a booster (24). Prokinetics have failed to show any additional benefit (25). PEG 2 liters + ascorbic acid preparation seems better than PEG 4 liter (26), and may also be used as a booster (27).…”