Should bowel preparation, antifoaming agents, or prokinetics be used before video capsule endoscopy? A systematic review and meta-analysis.
OBJECTIVE
The ideal bowel preparation regime before small bowel video capsule endoscopy (VCE) is not known. We carried out a systematic review and meta-analysis to study the effect of purgatives, antifoaming agents, and prokinetics on the outcomes associated with VCE.


METHODS
We performed literature searches in MEDLINE and Cochrane Library and included randomized-controlled trials studying the effect of purgatives, antifoaming agents, and prokinetics in patients undergoing VCE. Our outcomes of interest were visualization quality, diagnostic yield, and completion rate. Meta-analyses were carried out using the RevMan software and heterogeneity was assessed using the I statistic.


RESULTS
Fifteen studies fulfilled the inclusion criteria. As compared with no bowel preparation, bowel preparation with polyethylene glycol (PEG) led to adequate visualization in a significantly higher number of patients undergoing VCE [odds ratio (OR) 3.13; 95% confidence interval (CI) 1.70-5.75]. Both PEG and sodium phosphate significantly improved the diagnostic yield (OR 1.68; 95% CI 1.16-2.42 and OR 1.77; 95% CI 1.18-2.64, respectively) but did not affect the completion rate. All studies with simethicone showed significantly improved visualization quality with its use as compared with overnight fasting or purgatives alone. Prokinetics did not significantly improve the completion rate of VCE.


CONCLUSIONS
On the basis of the data available, a combination of PEG and simethicone appears to be the best approach for small bowel preparation before VCE. However, large multicenter randomized-controlled trials are needed to validate this recommendation and to evaluate the ideal dose of PEG and timing of bowel preparation before VCE. Prokinetics administered before VCE do not improve the completion rate and should not be used.
aDivision of Gastroenterology bDepartment of Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois, USA.
Vikram S
VS
Kotwal
Bashar M
BM
Attar
Saurabh
S
Gupta
Rajender
R
Agarwal
D000934:Antifoaming Agents / Q000008:administration & dosage* / Q000009:adverse effects; D053704:Capsule Endoscopy / Q000009:adverse effects; D002400:Cathartics / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D005769:Gastrointestinal Motility / Q000187:drug effects*; D006801:Humans; D007422:Intestines / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D016017:Odds Ratio; D010710:Phosphates / Q000008:administration & dosage; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012841:Simethicone / Q000008:administration & dosage
D000934:Antifoaming Agents; D002400:Cathartics; D010710:Phosphates; D011092:Polyethylene Glycols; D012841:Simethicone; C018279:sodium phosphate