Optimal preparation for video capsule endoscopy: a prospective, randomized, single-blind study

Background and study aim: Visualization of the small bowel by video capsule endoscopy (VCE) is frequently impaired by intestinal contents. Different bowel preparations have been studied with controversial results. The aim of this study was to determine a satisfactory and tolerable bowel preparation for VCE.

Methods: Ninety patients were randomized to three preparation regimens. Group A underwent VCE after clear liquid diet and overnight fast, while groups B and C received respectively 1 or 2 L of polyethylene glycol (PEG) solution before VCE. For each VCE five segments of 10 minutes were selected, one at the start of each quartile of the small-intestinal transit time, the fifth being the last 10 minutes of the ileum transit. Mucosal visibility was regarded as good if more than 75 % of the mucosa could be evaluated. All patients answered a questionnaire regarding procedure tolerability.

Results: The use of PEG solution led to a significant improvement in mucosal visualization. Mucosal visibility was good in the terminal ileum in 25 % of patients in group A, 52 % in group B, and 72 % in group C. The diagnostic yield did not change significantly. The use of 2 L of PEG solution was considered more uncomfortable than no PEG solution or 1 L of the same.

Conclusion: One liter of PEG solution improves mucosal visualization without causing discomfort for the patient.

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