Clinical utility of purgative bowel preparation before capsule endoscopy: a multicenter, blinded, randomized controlled trial

Lamba, Mehul; Ryan, Kimberley; Hwang, Jason; Grimpen, Florian; Lim, Gary; Cornelius, Dale; Moss, Alan; Lim, Eu Jin; Nguyen, Nam Q.; Tippett, Marcus; Taylor, Andrew; Appleyard, Mark

doi:10.1016/j.gie.2022.07.010

Cited by 7 publications

(5 citation statements)

References 32 publications

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“…Therefore, adequate SB visualization is a crucial element in ensuring a reliable assessment of the small intestine. Although the current ESGE technical guidelines specifically address this issue [47], the evidence is rapidly evolving [48] and remains somewhat controversial [49].…”

Section: Recommendationmentioning

confidence: 99%

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

et al. 2022

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Main Recommendations MR1 ESGE recommends small-bowel capsule endoscopy as the first-line examination, before consideration of other endoscopic and radiological diagnostic tests for suspected small-bowel bleeding, given the excellent safety profile of capsule endoscopy, its patient tolerability, and its potential to visualize the entire small-bowel mucosa.Strong recommendation, moderate quality evidence. MR2 ESGE recommends small-bowel capsule endoscopy in patients with overt suspected small-bowel bleeding as soon as possible after the bleeding episode, ideally within 48 hours, to maximize the diagnostic and subsequent therapeutic yield.Strong recommendation, high quality evidence. MR3 ESGE does not recommend routine second-look endoscopy prior to small-bowel capsule endoscopy in patients with suspected small-bowel bleeding or iron-deficiency anemia.Strong recommendation, low quality evidence. MR4 ESGE recommends conservative management in those patients with suspected small-bowel bleeding and high quality negative small-bowel capsule endoscopy.Strong recommendation, moderate quality evidence. MR5 ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by small-bowel capsule endoscopy.Strong recommendation, high quality evidence. MR6 ESGE recommends the performance of small-bowel capsule endoscopy as a first-line examination in patients with iron-deficiency anemia when small bowel evaluation is indicated.Strong recommendation, high quality evidence. MR7 ESGE recommends small-bowel capsule endoscopy in patients with suspected Crohn’s disease and negative ileocolonoscopy findings as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known bowel stenosis.Strong recommendation, high quality evidence. MR8 ESGE recommends, in patients with unremarkable or nondiagnostic findings from dedicated small-bowel cross-sectional imaging, small-bowel capsule endoscopy as a subsequent investigation if deemed likely to influence patient management.Strong recommendation, low quality evidence. MR9 ESGE recommends, in patients with established Crohn’s disease, the use of a patency capsule before small-bowel capsule endoscopy to decrease the capsule retention rate.Strong recommendation, moderate quality evidence. MR10 ESGE recommends device-assisted enteroscopy (DAE) as an alternative to surgery for foreign bodies retained in the small bowel requiring retrieval in patients without acute intestinal obstruction.Strong recommendation, moderate quality evidence. MR11 ESGE recommends DAE-endoscopic retrograde cholangiopancreatography (DAE-ERCP) as a first-line endoscopic approach to treat pancreaticobiliary diseases in patients with surgically altered anatomy (except for Billroth II patients).Strong recommendation, moderate quality evidence.

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Section: Recommendationmentioning

confidence: 99%

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

et al. 2022

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“…CE diagnostic yield is influenced not only by timing but also by cleansing level. Intestinal cleansing is controversial [12,13,14,15]. Although the latest ESGE recommendations include the use of pre-procedure laxatives [6], the absence of a universal cleansing scale hinders uniform data analysis, leading us not to require the classification of a specific scale when filling in the questionnaire.…”

Section: Discussionmentioning

confidence: 99%

“…Although the latest ESGE recommendations include the use of pre-procedure laxatives [6], the absence of a universal cleansing scale hinders uniform data analysis, leading us not to require the classification of a specific scale when filling in the questionnaire. In fact, due to the ambiguous opinions in the literature [6,12,13,14,15] we did not inquire about the use of different laxative protocols. Actually, the two centers in our study that achieved the minimum standard in "rate of adequate bowel preparation" did not use any purgative preparation before the procedure.…”

Section: Discussionmentioning

confidence: 99%

A comprehensive examination of small-bowel capsule endoscopy in Spanish centers to meet European Society of Gastrointestinal Endoscopy standards

Gómez Villagrá,

de Frías,

Martinez-Acitores de la Mata

et al. 2024

Endosc Int Open

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“…Our ndings are therefore consistent with recent RCTs evaluating the clinical effectiveness of PEG-based regimens and clear-uid alone in patients with suspected small bowel bleeding. 11,12 Commonly, the term "diagnostic accuracy" frequently used in clinical research, such as sensitivity, speci city etc., is replaced by "diagnostic yield" for the lack of further examinations to serve as reliable gold standard, which is a general methodological problem in SBCE studies. 27 It is tough to assess a precise association between positive lesion ndings and bleeding etiology.…”

Section: Discussionmentioning

confidence: 99%

“…4,9,10 Moreover, only two of these studies compared different bowel preparation methods for SBCE diagnostic yield in patients with suspected small bowel bleeding. 11,12 Compared to occult bleeding, overt SB, frequently in acute and severe cases, veri es a higher diagnostic yield of SBCE and a higher risk of recurrent bleeding, clamoring for prompt diagnosis and less discomfort in small bowel assessment. 1 Therefore, the aim of this retrospective study was to compare the bowel preparation with polyethylene glycol [PEG] versus fasting of acute or sub-acute suspected overt small bowel bleeding patients on ndings, diagnostic yield of SBCE.…”

Section: Introductionmentioning

confidence: 98%

Overnight Fasting only or Polyethylene Glycol Preparation for Capsule Endoscopy for detection of the Source of Overt Suspected Small Bowel Bleeding： a retrospective study

Dai

Ding

Pan

et al. 2023

Preprint

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Background Small bowel capsule endoscopy (SBCE) is recommended as the first choice of small bowel evaluation for suspected small bowel bleeding (SBB). However, there is no consensus on the cleansing criteria prior to SBCE. Aim We aimed to assess the effectiveness of the purgative regimen and the overnight fasting only method before undergoing SBCE. Methods This was a retrospective study of 102 patients who underwent SBCE to detect the source of active or sub-acute overt suspected SBB. 63 Patients in Group A consumed 2 L of PEG (Polyethylene glycol) before SBCE after an overnight fast; whereas 39 patients in Group B performed 12 hours overnight fast before the procedure. The primary endpoint was lesion findings and diagnostic yield, and the secondary endpoints were clinical outcomes, capsule endoscopy completion rate (CECR), transit time and the small bowel visualization quality (VQ). RESULTS The positive finding was ascertained in 38 patients in Group A (60.3%), and 18 in Group B (46.2%; P = 0.162). There was no significant difference in diagnosis yield in 2 groups (47.6% vs. 51.3%; P = 0.719), the same as the sensitivity (53.6% vs. 58.8%; P = 0.627) and specificity (71.4% vs. 100%; P = 0.470). The percentage of excellent or good small bowel VQ in Group A was significantly more than in Group B (57.2% vs. 38.5%, P = 0.0012). The median small-bowel transit time for Group A was statistically significant shorter than Group B (400 min vs. 519 min; P = 0.01). No evidence of differences was detected between the two groups in further treatment methods and prognosis(P = 0.209). CONCLUSION 2L PEG-based bowel preparation before SBCE does not result in improvement of diagnostic yield or clinical outcomes, although the small bowel visualization quality is enhanced.

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Clinical utility of purgative bowel preparation before capsule endoscopy: a multicenter, blinded, randomized controlled trial

Cited by 7 publications

References 32 publications

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

A comprehensive examination of small-bowel capsule endoscopy in Spanish centers to meet European Society of Gastrointestinal Endoscopy standards

Overnight Fasting only or Polyethylene Glycol Preparation for Capsule Endoscopy for detection of the Source of Overt Suspected Small Bowel Bleeding： a retrospective study

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