A NEW PREPARATION METHOD FOR IMPROVING GASTRIC MUCOSAL VISIBILITY AND CLEANLINESS DURING MAGNETICALLY ASSISTED CAPSULE ENDOSCOPY: A PROSPECTIVE STUDY
18 March 2019 (online)
Optimal mucosal visibility is essential during gastrointestinal endoscopy and it is even more important during magnetically assisted capsule endoscopy (MACE) as cleaning the mucosa during the procedure is not possible. Better pre-procedural preparation may improve the sensitivity and specificity of the MACE investigation. The aim of the current study was to compare the cleanliness of the stomach with or without our new gastric preparation protocol.
We performed a prospective study. 30 patients received our new gastric preparation protocol (Group A; 46,4 years; 50% female). Another 30 patients without gastric preparation served as controls (Group B; 47,1 years; 33,3% female). The same preparation protocol was used on the previous day (24 hours liquid diet, two doses of PEG). Group A received 200 mg simethicone 40 minutes, 40 mg pronase B and 1 mg sodium-bicarbonate 30 and 20 minutes before MACE, then patients were laid down and rotated every 5 minutes in 90 degrees increments around their axis, finally 600 ml clear water was given directly before swallowing the capsule. Group B had simethicone only before swallowing the water and the capsule. Typical pictures from the fundus, body and antrum were analyzed with a self developed software calculating the proportion of clean and covered surfaces of gastric mucosa.
The average proportion of covered areas were 7.26%-12.32% (fundus), 3.36%-9.22% (body) and 0.31%-6.14% (antrum) in group A vs. B respectively. The differences were statistically significant in all and more pronounced in body and antral regions (p = 0.0053, 0.0012 and 0.0321 in body, antrum and fundus, respectively).
The visibility and cleanliness of the whole gastric mucosa in our study could be significantly improved with specific gastric preparation. Therefore, we suggest our combined preparation protocol with simethicone and pronase to optimize the diagnostic performance of gastric MACE.