title: Lack of benefit of active preparation compared with a clear fluid-only diet in small-bowel visualization for video capsule endoscopy: results of a randomized, blinded, controlled trial.
abstract: OBJECTIVE
  Controversy remains regarding the type and amount of precapsule bowel cleansing required for small-bowel video capsule endoscopy (VCE). This study aims to assess the efficacy and tolerance of 2 active preparations and a control group of clear fluids only.
  
  
  METHODS
  Patients with clinical indications for VCE were randomized to (1) clear fluids only the evening before VCE, (2) 2 sachets of sodium picosulfate plus magnesium sulfate (P/MC) the evening before, or (3) 2 L of polyethylene glycol (PEG) the evening before. Diet instructions were the same for all 3 groups. Small-bowel cleansing was assessed in 3 ways: a 5-point ordinal scale (primary outcome), the percentage of time the small-bowel view was clear, and a validated computerized assessment of cleansing.
  
  
  RESULTS
  In total, 198 patients were randomized and 175 patients completed the trial with a mean age of 49.2 years. There was no clear benefit of active preparation with either P/MC or PEG over clear fluids only in the overall 5-point rating scale or in the distal fourth of each examination. There was no difference in diagnostic yield between groups. Significant differences were seen concerning tolerance of the preparations, with a higher proportion rating it as easy or very easy in the clear fluids-only group (93%) and the P/MC group (67%) than in the PEG group (13%) (P < .0001).
  
  
  CONCLUSIONS
  Small-bowel cleansing for VCE remains a controversial topic. This randomized control trial demonstrates no benefit in overall or distal small-bowel visualization with active preparation using either PEG or P/MC compared with clear fluids only. (Clinical trial registration number: NCT00677794.).
authors.affiliation: Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Hookey
authors.affiliation: Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada.
authors.forename: Jacob
authors.initials: J
authors.lastname: Louw
authors.affiliation: Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Wiepjes
authors.affiliation: Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Rubinger
authors.affiliation: Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Hoofddorp, the Netherlands.
authors.forename: Stijn
authors.initials: S
authors.lastname: Van Weyenberg
authors.affiliation: Clinical Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day
authors.affiliation: Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Paterson
mesh_terms: D000328:Adult; D000368:Aged; D001628:Beverages; D053704:Capsule Endoscopy / Q000379:methods*; D002400:Cathartics / Q000008:administration & dosage* / Q000009:adverse effects; D002951:Citrates / Q000008:administration & dosage; D004032:Diet; D005260:Female; D006801:Humans; D007421:Intestine, Small; D008278:Magnesium Sulfate / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage; D010342:Patient Acceptance of Health Care; D010847:Picolines / Q000008:administration & dosage; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011446:Prospective Studies; D016037:Single-Blind Method
chemical_list: D002400:Cathartics; D002951:Citrates; D009942:Organometallic Compounds; D010847:Picolines; D011092:Polyethylene Glycols; D008278:Magnesium Sulfate; C005701:picosulfate sodium