Clinical Endoscopy

Bowel preparation for small bowel capsule endoscopy: standard regimen with 2 L polyethylene glycol versus 1 L polyethylene glycol plus ascorbate: Riccardo Caccia, Alessandro Rimondi, Luca Elli, Matilde Topa, Flaminia Cavallaro, Carmine Gentile, Lucia Scaramella, Nicoletta Nandi, Reena Sidhu, Pinhas Eidler, Maurizio Vecchi, Gian Eugenio Tontini; Clin Endosc 2025;58(2):285-290. Published online January 2, 2025; DOI: https://doi.org/10.5946/ce.2024.097

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Background
/Aims: Optimization of bowel preparation for small bowel capsule endoscopy (SBCE) is debated. Guidelines recommend 2 L of iso-osmolar polyethylene glycol (PEG) to improve SBCE visibility. We compared the efficacy of the standard 2 L PEG solution with a 1 L PEG plus ascorbate (PEG-ASC) preparation, which has already been established for large-bowel preparation.
Methods
Between October 2020 and February 2022, patients undergoing SBCE were assigned to receive 2 L PEG or 1 L PEG-ASC bowel preparation on an even- or odd-day basis. Bowel cleanliness was evaluated using the small bowel mucosal visibility scoring system (SBMVSS).
Results
Following propensity score matching using a random forest method, two comparable populations of patients treated with 2 L PEG (n=74, male 41%, 53±17 years) and 1 L PEG-ASC (n=74, male 42%, 55±21 years) were obtained from the original cohort of 221 consecutive SBCE patients. Our results showed a trend towards more frequent adequate mucosal visibility with 1 L PEG-ASC compared to 2 L PEG (small bowel mucosal visibility ≥2 in all three small bowel tertiles, p=0.07), as per the SBMVSS score. No significant differences were observed in the diagnostic yield (p=1.00), visibility score=9 (p=0.85), SBCE completeness (p=0.33), or adequate mucosal visibility in each tertile (p=0.61, p=0.74, and p=0.70 for the first, second, and third tertiles, respectively).
Conclusions
Our study suggests the non-inferiority of the 1 L PEG-ASC solution over the standard 2 L PEG for SBCE preparation.

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Optimizing Bowel Preparation in Small Bowel Capsule Endoscopy: It's All About Timing
Vaneet Jearth, Kshitiz Dogra
Journal of Digestive Endoscopy.2025; 16(02): 113. CrossRef

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Effect of antithrombotic therapies on small bowel bleeding: an European multicenter retrospective study: Lucia Scaramella, Stefania Chetcuti Zammit, Reena Sidhu, Maurizio Vecchi, Gian Eugenio Tontini, Nicoletta Nandi, Matilde Topa, Luca Elli; Clin Endosc 2025;58(1):102-111. Published online December 2, 2024; DOI: https://doi.org/10.5946/ce.2024.073

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Background
/Aims: Small bowel bleeding (SBB) is the main indication for videocapsule endoscopy (VCE); the diagnostic yield (DY) could be influenced by antithrombotic therapies. We explored the effects of these therapies on SBB.
Methods
Consecutive patients from two centers (Milan, Italy and Sheffield, UK) who underwent VCE between March 2001 and July 2020 were considered. Demographic data, clinical parameters, drug therapy, and technical characteristics of the procedure were collected. VCE findings and DY were evaluated.
Results
In total, 957 patients (1,052 VCEs) underwent VCE for SBB (DY 50.6%, no retention); 27 patients (27 VCEs) received direct oral anticoagulants, 87 (88 VCEs) received other anticoagulants, 115 (135 VCEs) received antiplatelet therapy, 198 (218 VCEs) received monotherapy, and 31 (32 VCEs) received combined therapy. There were no differences in the completion rate, findings, and DYs between each subgroup or between monotherapy and combined therapy. The overt bleeding rate was similar in all groups, even when comparing antithrombotic users versus those not on therapy (p=0.59) or monotherapy versus combined therapy (p=0.34).
Conclusions
VCE is safe and has a high clinical impact on SBB. Antithrombotic therapies did not affect DY or overt bleeding rate and, consequently, can be considered safe in terms of SBB risk.

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Antithrombotic and management of small bowel bleeding – time to throw caution into the wind?
Lucia Scaramella, Agostino Cosenza, Cristina Romero-Mascarell, Luca Elli
Current Opinion in Gastroenterology.2026; 42(3): 146. CrossRef
Recent technological advances in video capsule endoscopy: a comprehensive review
Minjee Kim, Hyun Joo Jang
Clinical Endoscopy.2026; 59(2): 182. CrossRef
Do all antithrombotic agents have a similar impact on small bowel bleeding?
Chung Hyun Tae, Ki-Nam Shim
Clinical Endoscopy.2025; 58(1): 80. CrossRef

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Capsule enteroscopy versus small-bowel ultrasonography for the detection and differential diagnosis of intestinal diseases: Luca Elli, Erica Centorrino, Andrea Costantino, Maurizio Vecchi, Stefania Orlando, Mirella Fraquelli; Clin Endosc 2022;55(4):532-539. Published online July 28, 2022; DOI: https://doi.org/10.5946/ce.2021.224

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Background
/Aims: Capsule enteroscopy (CE) and intestinal ultrasonography (IUS) are techniques that are currently used for investigating small-bowel (SB) diseases. The aim of this study was to compare the main imaging findings and the lesion detection rate (LDR) of CE and IUS in different clinical scenarios involving the SB.
Methods
We retrospectively enrolled patients who underwent CE and IUS for obscure gastrointestinal bleeding (OGIB), complicated celiac disease (CeD), and suspected or known inflammatory bowel disease (IBD). We evaluated the LDR of both techniques. The accuracy of IUS was determined using CE as the reference standard.
Results
A total of 159 patients (113 female; mean age, 49±19 years) were enrolled. The LDR was 55% and 33% for CE and IUS (p<0.05), respectively. Subgroup analysis showed that the LDR of CE was significantly higher than that of IUS in patients with OGIB (62% vs. 14%, p<0.05) and CeD (55% vs. 35%, p<0.05). IUS showed a similar LDR to CE in patients with suspected or known IBD (51% vs. 46%, p=0.83).
Conclusions
CE should be preferred in cases of OGIB and CeD, whereas IUS should be considered an early step in the diagnosis and follow-up of IBD even in patients with a proximal SB localization of the disease.

Citations

Citations to this article as recorded by

Recent technological advances in video capsule endoscopy: a comprehensive review
Minjee Kim, Hyun Joo Jang
Clinical Endoscopy.2026; 59(2): 182. CrossRef
Saudi consensus guidance for the diagnosis and management of inflammatory bowel disease in children and adolescents
Omar I. Saadah, Turki AlAmeel, Ahmed Al Sarkhy, Mohammed Hasosah, Abdulrahman Al-Hussaini, Majid A. Almadi, Badr Al-Bawardy, Talal A. Altuwaijri, Mohammed AlEdreesi, Shakir A. Bakkari, Othman R. Alharbi, Nahla A. Azzam, Abdulelah Almutairdi, Khalidah A. A
Saudi Journal of Gastroenterology.2025; 31(3): 107. CrossRef
Small bowel ultrasound: friend or foe?
James Wild, Nicoletta Nandi, Thean Soon Chew, Benjamin Rea, Reena Sidhu
Current Opinion in Gastroenterology.2025; 41(3): 154. CrossRef
Intestinal ultrasound in Crohn’s disease: A systematic review of its role in diagnosis, monitoring, and treatment response
Partha Pal, Mohammad Abdul Mateen, Kanapuram Pooja, Nandhakumar Rajadurai, Rajesh Gupta, Manu Tandan, Nageshwar Reddy Duvvuru
World Journal of Meta-Analysis.2025;[Epub] CrossRef
Past, Present, and Future of Noninvasive Tests to Assess Gluten Exposure, Celiac Disease Activity, and End-Organ Damage
Jocelyn A. Silvester, Luca Elli, Chaitan Khosla, Jason A. Tye-Din
Gastroenterology.2024; 167(1): 159. CrossRef
The role of videocapsule endoscopy in the diagnosis and follow-up of celiac disease: a scoping review
Roberta Elisa Rossi, Valeria Poletti, Benedetta Masoni, Angelo Zullo, Matteo Colombo, Cesare Hassan, Alessandro Repici
Expert Review of Gastroenterology & Hepatology.2024; 18(10): 673. CrossRef
A practical approach for small bowel bleeding
Sung Eun Kim, Hyun Jin Kim, Myeongseok Koh, Min Cheol Kim, Joon Sung Kim, Ji Hyung Nam, Young Kwan Cho, A Reum Choe
Clinical Endoscopy.2023; 56(3): 283. CrossRef
Small Bowel Imaging in Celiac Disease: Is there a role for Small Bowel Ultrasound?
Roberta Elisa Rossi, Anita Busacca, Luca Brandaleone, Benedetta Masoni, Sara Massironi, Mirella Fraquelli, Alessandro Repici
Current Gastroenterology Reports.2023; 25(12): 430. CrossRef

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