Small bowel preparations for capsule endoscopy with mannitol and simethicone: a prospective, randomized, clinical trial.
OBJECTIVE
There is no consensus concerning small bowel preparation before capsule endoscopy (CE). This study evaluated the effects of 4 regimens on small bowel cleansing and diagnostic yield.


METHODS
Patients were randomly divided into 4 groups. Group A consumed a clear liquid diet after lunch on the day before CE, followed by overnight fasting. Group B took 250 mL 20% mannitol and 1 L 0.9% saline orally at 05:00 hours on the day of the procedure. In group C, the same regimen was taken at 20:00 hours on the day before and at 05:00 hours on the day of CE. In group D, in addition to the group C regimen, 20 mL oral simethicone was taken 30 minutes before CE.


RESULTS
Two hundred patients were prospectively enrolled, and 7 were excluded from the final analysis because of incomplete small bowel transit. No significant difference was noted among the 4 groups for small bowel transit time. Bowel preparation in group D was significantly better than for the other regimens for overall cleansing of the proximal small bowel, and showed improved overall cleansing of the distal small bowel when compared with 10-hours overnight fasting. Pathological lesions of the proximal and distal small bowel were, respectively, achieved in 82 and 74 patients, mostly distributed in group D.


CONCLUSIONS
Small bowel preparation that involves split-dose oral mannitol plus single-dose simethicone for CE can improve mucosal visualization and subsequent diagnostic yield when compared with 10-hours overnight fasting.
Chen
Hong-bin
HB
Department of Gastroenterology, Sanming First Affiliated Hospital of Fujian Medical University, Sanming, China. smchb2008@qq.com
Huang
Yue
Y
Chen
Su-yu
SY
Song
Hui-wen
HW
Li
Xiao-lin
XL
Dai
Dong-lin
DL
Xie
Jia-tia
JT
He
Song
S
Zhao
Yuan-yuan
YY
Huang
Chun
C
Zhang
Sheng-jun
SJ
Yang
Lin-na
LN
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000934:Antifoaming Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D053704:Capsule Endoscopy / Q000379:methods*; D004234:Diuretics, Osmotic / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005772:Gastrointestinal Transit / Q000187:drug effects; D006801:Humans; D007421:Intestine, Small / Q000187:drug effects*; D008297:Male; D008353:Mannitol / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D011292:Premedication; D011446:Prospective Studies; D012841:Simethicone / Q000008:administration & dosage / Q000627:therapeutic use*; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
D000934:Antifoaming Agents; D004234:Diuretics, Osmotic; D008353:Mannitol; D012841:Simethicone