Are bowel purgatives and prokinetics useful for small-bowel capsule endoscopy? A prospective randomized controlled study.
BACKGROUND
Capsule endoscopy (CE) is limited by incomplete small-bowel transit and poor view quality in the distal bowel. Currently, there is no consensus regarding the use of bowel purgatives or prokinetics in CE.


OBJECTIVE
To evaluate the usefulness of bowel purgatives and prokinetics in small-bowel CE.


METHODS
Prospective single-blind randomized controlled study.


METHODS
Academic endoscopy unit.


METHODS
A total of 150 patients prospectively recruited.


METHODS
Patients were randomized to 1 of 4 preparations: "standard" (fluid restriction then nothing by mouth 12 hours before the procedure, water and simethicone at capsule ingestion [S]); "standard" + 10 mg oral metoclopramide before the procedure (M); Citramag + senna bowel-purgative regimen the evening before CE (CS); Citramag + senna + 10 mg metoclopramide before the procedure (CSM).


METHODS
Gastric transit time (GTT) and small-bowel transit time (SBTT), completion rates (CR), view quality, and patient acceptability.


METHODS
positive findings, diagnostic yield.


RESULTS
No significant difference was noted among groups for GTT (median [minutes] M, CS, and CSM vs S: 17.3, 24.7, and 15.1 minutes vs 16.8 minutes, respectively; P = .62, .18, and .30, respectively), SBTT (median [minutes] M, CS, and CSM vs S: 260, 241, and 201 vs 278, respectively; P = .91, .81, and .32, respectively), or CRs (85%, 85%, and 88% vs 89% for M, CS, and CSM vs S, respectively; P = .74, .74, and 1.00, respectively). There was no significant difference in view quality among groups (of 44: 38, 37, and 40 vs 37 for M, CS, and CSM, vs S, respectively; P = .18, .62, and .12, respectively). Diagnostic yield was similar among the groups. CS and CSM regimens were significantly less convenient (P < .001), and CS was significantly less comfortable (P = .001) than standard preparation.


CONCLUSIONS
Bowel purgatives and prokinetics do not improve CRs or view quality at CE, and bowel purgatives reduce patient acceptability.
Postgate
Aymer
A
Wolfson Unit for Endoscopy, St. Mark's Hospital, Imperial College London, UK. apostgate@yahoo.com
Tekkis
Paris
P
Patterson
Neil
N
Fitzpatrick
Aine
A
Bassett
Paul
P
Fraser
Chris
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy / Q000379:methods*; D002400:Cathartics / Q000008:administration & dosage* / Q000009:adverse effects; D019343:Citric Acid / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects*; D005772:Gastrointestinal Transit / Q000187:drug effects*; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis*; D007421:Intestine, Small / Q000187:drug effects; D008274:Magnesium / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008787:Metoclopramide / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D011292:Premedication; D011446:Prospective Studies; D012676:Senna Extract / Q000008:administration & dosage* / Q000009:adverse effects; D012841:Simethicone / Q000008:administration & dosage* / Q000009:adverse effects; D016037:Single-Blind Method; D055815:Young Adult
D002400:Cathartics; D004338:Drug Combinations; C005479:magnesium carbonate; D019343:Citric Acid; D012676:Senna Extract; D012841:Simethicone; D008274:Magnesium; D008787:Metoclopramide