Intestinal preparation for small bowel capsule endoscopy: polyethylene glycol alone or polyethylene glycol with ascorbic acid?

Aims Compare the rate of complete examinations, quality of bowel preparation, diagnostic yield, small bowel transit time and tolerability, in small bowel capsule endoscopy (SBCE), using 2 different protocols for intestinal preparation.

Methods Prospective, randomized study including consecutive patients submitted to SBCE. During the day before, all patients followed a clear liquid diet. In the day of the exam, the capsule was ingested with water and 100 mg of simethicone. Once the capsule reached the small bowel, patients ingested a booster, randomized into one of two protocols: protocol 1 using 1L of polyethylene glycol (PEG) or protocol 2 using 1L of PEG and ascorbic acid. The patients’ bowel preparation was assessed using the Small Bowel CLEansing Assessment and Report (SB-CLEAR)¹. Additionally, at the end of the exam, each patient responded to a questionnaire, answering if they ingested all the booster and what was their tolerability in a scale from 0 (very easy) to 5 (very difficult).

Results Included 100 patients, 49 from protocol 1 and 51 from protocol 2. Most patients were female (62.0%), with a median age of 49 years. Thirty-nine patients had relevant findings in SBCE (39.0%). There were 6 patients with an incomplete small bowel examination (6.0%) and 12 with inadequate bowel preparation (12.0%).

There were no statistically significant differences between patients from both protocols regarding sex and age (p=0.798 and p=0.707, respectively). The rate of complete examinations, adequate bowel preparation and diagnostic yield was comparable between both groups: 95.9% vs 92.2% (p=0.678), 87.8% vs 88.2% (p=0.941) and 46.9% vs 31.4% (p=0.111), respectively. The same occurred with small bowel transit time (164 vs 161 minutes, p=0.620) and SB-CLEAR score (8 vs 9, p=0.176). Additionally, no significant differences were found between patients from both protocols, regarding the ingestion of the whole booster and the patients’ tolerability: 83.7% vs 82.4% (p=0.860) and 3 vs 4, in a 0-5 scale (p=0.703), respectively. Considering the patients’ tolerability, women reported a higher difficulty in ingesting the booster using a 0-5 scale, regardless of the protocol (4 vs 2, p=0.001). No association was found between the patients’ tolerability and age (p=0.307). [1]

Conclusions The use of ascorbic acid associated with PEG solutions for intestinal preparation in SBCE was comparable to same volume PEG solutions alone in terms of rate of complete examinations, adequate bowel preparation and diagnostic yield. There were also no differences in the ingestion of the whole booster and patients’ tolerability between the use of PEG alone or PEG with ascorbic acid. Finally, women report more difficulty in tolerating intestinal preparation for SBCE, regardless of the protocol.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Macedo Silva V, Lima Capela T, Freitas M, Sousa Magalhães R, Arieira C, Xavier S. et al. Small Bowel CLEansing Assessment and Report (SB-CLEAR): Standardizing bowel preparation report in capsule endoscopy. J Gastroenterol Hepatol 2023; 38 (05) 747-51

Publikationsverlauf

Artikel online veröffentlicht:
15. April 2024