Visualization of the Small Intestine Using Capsule Endoscopy in Healthy Subjects

Abstract

The actual extent of lumen visualized by capsule endoscopy has not been studied systematically. Volunteers were randomized to receive a bowel preparation (prep) consisting of an isotonic solution containing polyethylene glycol and simethicone. The prep (200 ml) was given 30 min before the capsule. The capsule was taken with 100 ml of prep and 100 ml of water; 100 ml of prep was given 45 and 75 min later. The control administration was 100 ml of water and no simethicone. Forty percent of all frames taken in the small bowel were examined and individually scored for circumference, bubbles, debris, and lighting. Nine volunteers were studied twice. Only 50% of the circumference is seen normally. The prep improved the circumference to 62.5% as well as decreasing luminal debris and bubbles and improving the lighting. We conclude that the prep solution improved small bowel visualization, however, improvements are still needed to optimize visualization.

Small bowel capsule endoscopy in 2007: Indications, risks and limitations

“…Since capsule endoscopy was introduced in clinical practice 6 years ago, some papers explored also the impact of this new technique on the outcome of patients with obscure GI bleeding. As expected, capsule endoscopy has been found to significantly modify the diagnostic and therapeutic work up immediately after the examination [33] , decreasing the number of further examinations and reducing the length of hospital stay [10,34,35] . Nevertheless capsule endoscopy seems also to have a positive impact on long term follow up (mostly evaluated at 12-18 mo after the examination) in about 50%-66% [28,32] of patients and even patients with negative capsule endoscopy have a low probability of experiencing a new bleeding episode (the negative predictive value of capsule endoscopy ranges between 83% and 100%) [34,36] .…”

“…Unfortunately about a quarter of published papers are case reports (187) or collections of small case series and 131 published papers are expert reviews. Following the rules of evidence based medicine [9] we can classify these papers at the lowest level of scientific evidence while, among the huge number of publications about capsule endoscopy, there are only 8 randomized controlled studies [five about bowel preparation, 2 about Nonsteroidal anti-inflammatory drugs (NSAIDs) induced damage and 1 about obscure GI bleeding (OGIB)] [10][11][12][13][14][15][16][17] and 4 metanalyses (about OGIB or Crohn's disease) [18][19][20][21] ; all these papers can be ranked as evidence grade 1c.…”

Effectiveness of Magnesium Citrate as Preparation for Capsule Endoscopy: A Randomized, Prospective, Open-Label, Inter-Group Trial

“…In principle, CE is a procedure that can only be performed in the fasting state [10]. In order to improve observational yield, diagnostic yield, and the large bowel arrival rate, a number of studies have been conducted using a variety of preparations (table 4) [5,6,7,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30]. However, studies evaluating the efficacy of MC as bowel preparation are currently very limited in number [22,24].…”

“…Accordingly, rather than the tonicity of the MC solution, it may be that the timing of administration most affects the clarity of the digestive juice. Even for PEG, in trials where patients are administered a laxative on the day of the procedure or during the procedure, few studies have confirmed cleansing efficacy [17,18]. This point requires comparison of differences in cleansing efficacy according to the timing of laxative administration.…”

The Relationship between Physical Activity Level and Completion Rate of Small Bowel Examination in Patients Undergoing Capsule Endoscopy

“…Modifications of 3 major factors, specifically bowel preparations, use of prokinetics and postural strategies have been tried with the aim of improving the CE images (4,5). Regarding bowel preparations, polyethylene glycol (PEG) (6)(7)(8)(9)(10)(11), sodium phosphate (NaP) (10)(11)(12)(13), and simethicone (14,15) have been extensively evaluated for use in CE. However, these preparations produce both physical and psychological discomfort, potentially impacting patient compliance.…”