Purgative bowel cleansing combined with simethicone improves capsule endoscopy imaging.
OBJECTIVE
To evaluate the effects of the various methods of small bowel preparation on the quality of visualization of the small bowel and the gastrointestinal transit time of capsule endoscopy (CE).


METHODS
Ninety patients referred for CE were prospectively randomized to three equal groups according to the preparation used: (a) a control group, in which patients were requested to drink 1 L of clear liquids only, 12 h before the examination; (b) a purgative group, in which patients were requested to ingest 1 L of a polyethylene glycol (PEG)/electrolyte solution only, 12 h before the examination; or (c) a purgative combined with simethicone group (P-S group), in which patients were requested to ingest 1 L of PEG, 12 h before the examination, and 300 mg of simethicone, 20 min before the examination. Effects of the different bowel preparations on the gastric transit time (GTT), small bowel transit time (SBTT), examination completion rate, quality of images of the entire small intestine, and cleansing of the proximal small bowel and distal ileum were evaluated.


RESULTS
The number of patients with "adequate" cleansing of the entire small intestine was 17 in the P-S group, 12 in the purgative group, and seven in the control group (P= 0.002). The P-S group had significantly better image quality than the control group (P= 0.001). The P-S group had significantly better image quality for the proximal small bowel (segment A [Seg A]) than the control group (P= 0.0001). Both the P-S group (P= 0.0001) and the purgative group (P= 0.0002) had significantly better image quality for the distal ileum (segment B [Seg B]) than the control group; the P-S group had significantly better image quality than the purgative group as well (P= 0.0121). Gastrointestinal transit time was not different among the three groups, nor was the examination completion rate.


CONCLUSIONS
Purgative bowel cleansing combined with simethicone before CE improved the quality of imaging of the entire small bowel as well as the visualization of the mucosa in the proximal and distal small intestine.
Wei
Wei
W
Department of Gastroenterology, Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ge
Zhi-Zheng
ZZ
Lu
Hong
H
Gao
Yun-Jie
YJ
Hu
Yun-Biao
YB
Xiao
Shu-Dong
SD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000934:Antifoaming Agents / Q000008:administration & dosage; D053704:Capsule Endoscopy / Q000379:methods*; D002648:Child; D004333:Drug Administration Routes; D005260:Female; D005500:Follow-Up Studies; D005772:Gastrointestinal Transit / Q000187:drug effects; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000503:physiopathology; D007421:Intestine, Small; D008297:Male; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011446:Prospective Studies; D015203:Reproducibility of Results; D012841:Simethicone / Q000008:administration & dosage; D013501:Surface-Active Agents / Q000008:administration & dosage
D000934:Antifoaming Agents; D013501:Surface-Active Agents; D011092:Polyethylene Glycols; D012841:Simethicone