Guidelines for Bowel Preparation before Video Capsule Endoscopy

Hyun Joo Song; Jeong Seop Moon; Jae Hyuk Do; In Hye Cha; Chang Hun Yang; Myung-Gyu Choi; Yoon Tae Jeen; Hyun Jung Kim; Korean Gut Image Study Group

doi:10.5946/ce.2013.46.2.147

Articles

Page Path: HOME > Clin Endosc > Volume 46(2); 2013 > Article

Review Guidelines for Bowel Preparation before Video Capsule Endoscopy: Hyun Joo Song¹, Jeong Seop Moon², Jae Hyuk Do³, In Hye Cha², Chang Hun Yang⁴, Myung-Gyu Choi⁵, Yoon Tae Jeen⁶, Hyun Jung Kim⁷, Korean Gut Image Study Group⁸; Clinical Endoscopy 2013;46(2):147-154.
DOI: https://doi.org/10.5946/ce.2013.46.2.147
Published online: March 31, 2013

¹Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.

²Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea.

³Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

⁴Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea.

⁵Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

⁶Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

⁷Institute for Evidence-Based Medicine, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.

⁸Korean Gut Image Study Group, Korean Society of Gastrointestinal Endoscopy, Seoul, Korea.

Correspondence: Jeong Seop Moon. Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, 9 Mareunnae-ro, Jung-gu, Seoul 100-032, Korea. Tel: +82-2-2270-0012, Fax: +82-2-2279-4021, moonjs2@unitel.co.kr

• Received: February 28, 2012 • Revised: April 24, 2012 • Accepted: April 24, 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

9,507 Views
172 Download
37 Crossref
45 Scopus

prev next

Full Article

Download PDF

Abstract
INTRODUCTION
GUIDELINES FOR BOWEL PREPARATION
CONCLUSIONS
NOTES
REFERENCES

Abstract

The preparation for video capsule endoscopy (VCE) of the bowel suggested by manufacturers of capsule endoscopy systems consists only of a clear liquid diet and an 8-hour fast. While there is evidence for a benefit from bowel preparation for VCE, so far there is no domestic consensus on the preparation regimen in Korea. Therefore, we performed this study to recommend guidelines for bowel preparation before VCE. The guidelines on VCE were developed by the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy. Four key questions were selected. According to our guidelines, bowel preparation with polyethylene glycol (PEG) solution enhances small bowel visualization quality (SBVQ) and diagnostic yield (DY), but it has no effect on cecal completion rate (CR). Bowel preparation with 2 L of PEG solution is similar to that with 4 L of PEG in terms of the SBVQ, DY, and CR of VCE. Bowel preparation with fasting or PEG solution combined with simethicone enhances the SBVQ, but it does not affect the CR of VCE. Bowel preparation with prokinetics does not enhance the SBVQ, DY, or CR of VCE.
Keywords: Capsule endoscopy; Bowel preparation; Guideline

INTRODUCTION

The necessity

Several factors, such as food material, air bubbles in the small bowel and delayed gastric and small bowel transit time (SBTT) influence small bowel visualization quality (SBVQ), diagnostic yield (DY), and completion rate (CR) in video capsule endoscopy (VCE). The results of studies on bowel preparation before VCE using purgatives such as polyethylene glycol (PEG), sodium phosphate and simethicone (polydimethylsiloxane and silicon dioxide), or prokinetics are conflicting. Therefore, there were no proposed standard guidelines for bowel preparation before VCE.

The objectives

In Korea, different bowel preparation methods have been used in each hospital, presumably expecting undefined advantages without evidence or knowledge of the strengths and weaknesses of various methods. The present set of guidelines was developed by the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy. The objectives of these guidelines are to provide accurate information and to suggest a protocol for proper bowel preparation before VCE to medical professionals, based on analyzed evidence of published studies.

Participants

To prepare these guidelines, a multisociety operating committee on VCE guidelines and a working committee were formed in April 2010, consisting of experts and clinical treatment guideline professionals recommended by the Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, and the Korean Association for the Study of the Intestinal Diseases.

Choice of key questions

A survey was conducted, based on a working committee meeting, to select four key questions regarded as pivotal to medical professionals and patients concerning bowel preparation before VCE.

Literature searching and selection

We performed online searches for VCE bowel preparation-related clinical studies, comparative researches, randomized controlled trials (RCTs), meta-analyses and guidelines published from January 2002 to October 2011. Systemic literature searches were made of the MEDLINE, EMbase, and Cochrane library databases for foreign literature, and of the KMbase, KISS, and KoreaMed for Korean literature. Key MeSH terms used (http://www.nlm.nih.gov/mesh/MBrowser.html) were "capsule endoscopy" and "bowel preparation." A total of 191 papers were selected. Additional searching was performed for papers on SBVQ, DY, cecal CR, PEG, simethicone and prokinetics. Conference abstracts, manuscripts published in languages other than English and reviews were excluded from the search. Among the initially selected publications, we reviewed the titles and abstracts to eliminate those that did not meet the criteria. When necessary, we carefully reviewed the entire documents. We excluded papers on VCE bowel preparation with sodium phosphate, mannitol, coffee enema, and bisacodyl and colon capsule bowel preparation. The 'PICO' rule was applied to the keywords used for searches in English. After excluding a total of 166 papers, we finally selected 25 and created a standardized evidence table to extract information pertinent to the four key questions.

Meta-analysis

After creating an evidence table for each key question, we conducted meta-analyses for key questions with search results based on RCTs. The pooled odds ratio (OR) for the SBVQ, DY, and CR of VCE for each key question and 95% confidence interval (CI) were calculated from each original study. SBVQ was included in the standardized evidence table, but a meta-analysis for this factor was excluded because of the different criteria used between reports. Each meta-analysis was iterated with exclusion of each study, one at a time, to assess the overall effect of the exclusion of the pooled ORs. Heterogeneity between studies was evaluated using Cochran Q-test; studies were considered heterogeneous if the Q-test gave p<0.10. The pooled estimate was assessed by an inverse variance weighted estimation method. If any statistical heterogeneity was found (p<0.10), a random effect model was applied. This model assumes that each study has a different underlying effect and this leads to wider CI values than with the fixed-effects model. The meta-analyses were performed using the Cochrane Review tool ReVman version 5.1 (The Cochrane Collaboration, Copenhagen, Denmark; http://ims.cochrane.org/revman).

Quality of evidence and grade of recommendations

We carefully reviewed the final candidate papers and wrote recommendations for each of four main questions based on comprehensive evidence, including the results of the meta-analyses. The methodology proposed by the Grading of Recommendations Assessment, Development and Evaluation Working Group was used to determine the quality of evidence. This indicates the level of scientific evidence of the recommendation and the strength of the recommendation, which means the level of strength at which the recommendation should be made (Table 1).1,2

The quality of evidence for each main outcome can be determined by considering the study design on which the evidence was based; that is, "high quality" for RCTs and "low quality" for observational studies. We then considered whether the studies had any serious limitations in the study design or execution, important inconsistencies in the results, or uncertainty about the directness of the evidence. Additional considerations that could lower the quality of evidence included imprecision of results or sparse data, and high risk of publication bias. Other considerations that could raise the quality of evidence in observational studies (which could not be any lower), included large effects, low possibility of plausible confounding effects, and a very strong association of any dose-response gradient. If there was no evidence from an RCT or observational studies, the recommendation from a consensus of experts based on clinical experience was classified as "expert opinion."

The strength of recommendation was assessed as two grades-" strong" or "weak"-considering the balance between desirable and undesirable consequences, quality of evidence, confidence in values and references, amount of medical expenses and effective allocation of resources. In general, when the desirable effects of an intervention clearly outweigh the undesirable effects, or vice versa, guideline panels can offer strong recommendations. On the other hand, when the trade offs are less certain, either because of a low quality of evidence or because evidence suggests that desirable and undesirable effects are closely balanced, weak recommendations become mandatory.1,2 Agreement was reached after internet-based voting by 15 members of the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy (see agreement percentages below).

Drafting of statements and approval

After writing a draft of the VCE guidelines based on the literature results, we conducted an internet survey to reflect the medical environment in Korea and to assess how VCE was being provided by medical professionals in actual clinical settings. Opinions from various professionals in Korea were solicited and compiled before having the draft recommendation approved.

Supply and implementation of the VCE guidelines

The published set of guidelines will be posted on the websites of the Korean Society of Gastrointestinal Endoscopy and Korean Association for the Study of the Intestinal Diseases. A summary of the guidelines highlighting important recommendations will be prepared and distributed to medical professionals free of charge.

GUIDELINES FOR BOWEL PREPARATION

Does bowel preparation with PEG solution enhances the SBVQ, DY, and CE of VCE?

Bowel preparation with PEG solution enhances the SBVQ, and DY of small bowel VCE, but it does not affect the VCE CR (evidence grade, moderate; recommendation grade, strong).

Agreement: agree strongly (53.3%); agree with minor reservations (46.7%); agree with major reservations (0%); disagree with major reservations (0%); disagree strongly (0%).

Concerning the SBVQ of bowel preparation with PEG solution for VCE, there are eight articles including six RCTs,3-8 one prospective nonrandomized study9 and one retrospective study.10 Most used a PEG volume of 2 L, but 500 mL was used in one article8 and 4 L in two.6,9 Five of the RCTs3,4,6-8 showed that bowel preparation with PEG solution enhanced the SBVQ compared with fasting alone or a clear liquid diet (p<0.05) and one prospective nonrandomized study also showed a statistically significant difference (p<0.01).9 Wi et al.5 showed no difference in the SBVQ between fasting and administration of 2 L of PEG solution (43% vs. 56%), but there was a significant difference in the SBVQ between fasting and bowel preparation with sodium phosphate (43% vs. 77%, p=0.002). A retrospective study by Ben-Soussan et al.10 showed no difference in the SBVQ between fasting and using 2 L of PEG, but it only included 42 patients and was a retrospective study. According to the meta-analysis of four articles evaluating SBVQ for VCE,3-6 the SBVQ was enhanced about fourfold (OR, 4.02; CI, 1.97 to 8.24) (Fig. 1).

Regarding the DY of using PEG solution for bowel preparation for VCE, there are five RCTs,3-5,7,8 and one retrospective study.10 According to a report by Viazis et al.3 in an RCT based on 80 patients, bowel preparation with 2 L PEG solution enhanced the DY compared with fasting or a clear liquid diet (65% vs. 40%, p=0.003); whereas the other five reports showed no significant differences. However, a meta-analysis of these five RCTs showed an enhanced DY for VCE (OR, 1.97; CI, 1.20 to 3.24) (Fig. 2).

Regarding the CR for VCE using PEG solution for bowel preparation, there are four RCTs,3,5,7,8 one prospective nonrandomized study9 and one retrospective study.10 Among these studies, there were no differences in the CR for VCE between patients prepared with PEG solution and those with fasting alone or a clear liquid diet.3,5,7,10 Meta-analysis of the four RCTs3,5,7,8 showed that there was no statistically significant difference in the CR for VCE between patients prepared with PEG solution and those with fasting alone or a clear liquid diet (OR, 1.56; CI, 0.78 to 3.12) (Fig. 3).

The European Society of Gastrointestinal Endoscopy (ESGE) guidelines in 2009 recommended that purgative bowel preparations would enhance the DY of a small bowel examination using VCE and would not affect the VCE CR (category of evidence 2a; grade of recommendation B).11 Pooled data from a meta-analysis of 12 articles published in 2009 showed that, in comparison with a clear liquid diet, purgative bowel preparation including PEG solution and sodium phosphate before undertaking VCE improved the SBVQ (OR, 2.133; CI, 1.252 to 3.566; p=0.005) and increased the DY (OR, 1.813; CI, 1.251 to 2.628; p=0.002).12 However, there was significant heterogeneity among the studies. According to this analysis, purgative bowel preparation showed no difference in gastric and SBTTs for VCE compared with a clear liquid diet. A meta-analysis of seven studies showed that purgative bowel preparation including PEG or sodium phosphate enhanced the SBVQ and DY of VCE (OR, 1.753; p=0.003). However, the use of sodium phosphate has been restricted in Korea because of its nephrotoxicity. Therefore, we excluded the use of sodium phosphate in this study. The present meta-analysis included the studies by Wi et al.,5 Park et al.,7 and Endo et al.8 published by up to October 2011. However, the previous meta-analysis only included studies published by up to February 2008.11 In conclusion, bowel preparation with PEG solution enhances the SBVQ and DY of small bowel VCE but does not affect the VCE CR.

Is bowel preparation with 4 L of PEG solution better than that with 2 L of PEG solution for the SBVQ, DY, and CR for VCE?

Bowel preparation with 4 L of PEG solution is similar to that with 2 L of PEG solution for the SBVQ, DY, and CR for VCE (evidence grade, moderate; recommendation grade, weak).

Agreement: agree strongly (33.3%); agree with minor reservations (66.7%); agree with major reservations (0%); disagree with major reservations (0%); disagree strongly (0%).

While there is evidence for a benefit of bowel preparation for VCE, so far there is no consensus on the optimal preparation regimen. Several investigators favor split-dosing of 2 L of purgatives in the evening before the examination. Others prefer a preparation similar to that for colonoscopy. However, a comparison between 2 or 4 L of PEG was not mentioned in the ESGE guidelines in 2009. As for the SBVQ, DY, and CE for VCE, there were two RCTs: one by Kantianis et al.13 in 2009 and another by Park et al.7 in 2011. Among 201 patients, there was no significant difference in the SBVQ for VCE between 2 L (n=101) and 4 L of PEG (n=100) (0.93 vs. 0.93, p=0.72).13 Among 45 patients, there was also no significant difference in the SBVQ for VCE between 2 L (n=20) or 4 L of PEG (n=25; 2.43 vs. 2.55).7 A meta-analysis of these two studies showed that the DY and CR were similar between the two groups (OR, 0.89; CI, 0.52 to 1.53, respectively) (Fig. 4) and (OR, 0.82; CI, 0.45 to 1.51, respectively) (Fig. 5). In conclusion, bowel preparation with 4 L of PEG solution is similar to using 2 L in terms of the SBVQ, DY, and CR for VCE. PEG 2 L rather than 4 L may be a useful method of preparation before undertaking VCE.

Does bowel preparation with fasting or PEG solution combined with simethicone enhance the SBVQ, DY, and CR for VCE?

Bowel preparation with fasting or administration of PEG solution combined with simethicone enhances the SBVQ, but it does not affect the CR for VCE (evidence grade, moderate; recommendation grade, strong).

Agreement: agree strongly (40%); agree with minor reservations (46.7%); agree with major reservations (13.3%); disagree with major reservations (0%); disagree strongly (0%).

A systemic review and meta-analysis of RCTs using simethicone for gastrointestinal endoscopic visibility was performed by Wu et al.14 in 2011. This study evaluated the SBVQ, DY, CR, gastric transit time (GTT) and SBTT for VCE. Four studies comparing purgative or fasting plus simethicone with purgative or fasting alone for VCE were identified. Patients who had supplemental simethicone before VCE achieved significantly better SBVQ (OR, 2.84; CI, 1.74 to 4.65; p=0.00) and similar CR (OR, 0.80; CI, 0.44 to 1.44; p=0.454).14 This study concluded that the supplemental use of simethicone before VCE improved the SBVQ, especially for patients who received no purgative, but did not affect the VCE CR.

There are five RCTs on the SBVQ for VCE following the use of PEG solution with simethicone.15-19 We included the study by Fang et al.15 involving 64 healthy subjects; this was excluded from the previously reported systemic review and meta-analysis because it used healthy volunteers. Among these five RCTs, two compared fasting alone with fasting plus simethicone.16,17 Among the remaining three RCTs, purgative bowel cleansing combined with simethicone before VCE improved the SBVQ compared with purgative bowel cleansing alone.15,18,19 However, a study of 58 patients by Spada et al.19 showed no difference in the SBVQ for VCE between the use of PEG plus simethicone and fasting alone (42% vs. 43%, p=0.86). A meta-analysis of four RCTs comparing fasting or PEG solution plus simethicone with clear liquid revealed that the SBVQ was improved (OR, 3.53; CI, 1.36 to 9.17) (Fig. 6). Only one study examined the DY of VCE and showed no difference in the SBVQ before VCE or in the DY.19 Therefore, further studies are needed to determine the DY of VCE in this area.

There were three RCTs examining the CR of VCE.16,18,19 A meta-analysis of these articles found no difference between fasting or PEG solution plus simethicone and clear liquid (OR, 0.73; CI, 0.37 to 1.47) (Fig. 7). In conclusion, bowel preparation with fasting or administration of PEG solution combined with simethicone enhances the SBVQ, but it does not affect the CR for VCE.

Does the use of prokinetics enhance the SBVQ, DY, or CR of VCE?

Bowel preparation with prokinetics does not enhance the SBVQ, DY, or CR of VCE. Therefore, it is not generally recommended (evidence grade, moderate; recommendation grade, weak).

Agreement: agree strongly (40%); agree with minor reservations (40%); agree with major reservation (20%); disagree with major reservation (0%); disagree strongly (0%).

With a limited battery life, VCE can take images for up to 8 hours and about 20% of them do not reach the colon by the end of the recording time.20 Therefore, there have been several studies about the use of prokinetics for shortening the GTT and SBTT during VCE. It is uncertain whether the use of prokinetics improves the CR for VCE. There are eight reports on the use of prokinetics with VCE: three on metroclopramide, three on erythromycin and one each on mosapride and lubiprostone.21-28 There are six articles on the SBVQ for VCE using prokinetics: two RCTs on metroclopramide;21,22 one RCT,24 one prospective nonrandomized study,25 and one retrospective blinded study on erythromycin;26 and one RCT on lubiprostone.28 A meta-analysis of these reports was impossible because they used different criteria for the SBVQ of VCE. However, there were no statistically significant differences in the SBVQ of VCE in these studies.

There were five studies on the DY of VCE with the use of prokinetics: three RCTs on metroclopramide,21-23 one retrospective blinded study on erythromycin26 and one RCT on mosapride.27 A meta-analysis of the four RCTs21-23,27 showed that the DY of VCE was not improved (OR, 1.23; CI, 0.75 to 2.03) (Fig. 8).

There were seven studies on the effect of using prokinetics on the CR of VCE.21-27 A prospective RCT on the use of metoclopramide in 150 patients showed a statistically significant difference in the CR of VCE (97% vs. 76%, p<0.001).23 Another prospective RCT on the use of mosapride in 60 patients also showed a statistically significant difference in the CR of VCE (73.3% vs. 66.7%, p=0.021).27 However, the other five studies did not show any statistically significant differences in the CR of VCE. A meta-analysis of five of the prospective RCTs on prokinetics21-24,27 showed no statistically significant difference between the use of prokinetics and placebo or fasting alone (OR, 2.25; CI, 0.82 to 6.17) (Fig. 9). Although the use of prokinetics can shorten the GTT, this cannot improve the CR of VCE. These days, the battery life of capsules is about 12 hours, so the effect of prokinetics on the CR of VCE might be minimal. Since there is no meta-analysis on the DY and CR of VCE associated with the use of prokinetics, this study has a value of meta-analysis of the previous reports. Therefore, bowel preparation with prokinetics does not enhance the SBVQ, DY, or CR of VCE and it is not generally recommended.

CONCLUSIONS

1) Bowel preparation with PEG solution enhances the SBVQ, and DY of small bowel VCE, but it does not affect the VCE CR (evidence grade, moderate; recommendation grade, strong).

2) Bowel preparation with 4 L of PEG solution is similar to that with 2 L of PEG solution for the SBVQ, DY, and CR for VCE (evidence grade, moderate; recommendation grade, weak).

3) Bowel preparation with fasting or administration of PEG solution combined with simethicone enhances the SBVQ, but it does not affect the CR for VCE (evidence grade, moderate; recommendation grade, strong).

4) Bowel preparation with prokinetics does not enhance the SBVQ, DY, or CR of VCE. Therefore, it is not generally recommended. (evidence grade, moderate; recommendation grade, weak).

The authors have no financial conflicts of interest.

REFERENCES

1. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924–926.Article PubMed PMC
2. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490.Article PubMed PMC
3. Viazis N, Sgouros S, Papaxoinis K, et al. Bowel preparation increases the diagnostic yield of capsule endoscopy: a prospective, randomized, controlled study. Gastrointest Endosc 2004;60:534–538.Article PubMed
4. van Tuyl SA, den Ouden H, Stolk MF, Kuipers EJ. Optimal preparation for video capsule endoscopy: a prospective, randomized, single-blind study. Endoscopy 2007;39:1037–1040.Article PubMed
5. Wi JH, Moon JS, Choi MG, et al. Bowel preparation for capsule endoscopy: a prospective randomized multicenter study. Gut Liver 2009;3:180–185.Article PubMed PMC
6. Rey JF, Repici A, Kuznetsov K, Boyko V, Aabakken L. Optimal preparation for small bowel examinations with video capsule endoscopy. Dig Liver Dis 2009;41:486–493.Article PubMed
7. Park SC, Keum B, Seo YS, et al. Effect of bowel preparation with polyethylene glycol on quality of capsule endoscopy. Dig Dis Sci 2011;56:1769–1775.Article PubMed
8. Endo H, Kondo Y, Inamori M, et al. Ingesting 500 ml of polyethylene glycol solution during capsule endoscopy improves the image quality and completion rate to the cecum. Dig Dis Sci 2008;53:3201–3205.Article PubMed
9. Dai N, Gubler C, Hengstler P, Meyenberger C, Bauerfeind P. Improved capsule endoscopy after bowel preparation. Gastrointest Endosc 2005;61:28–31.Article PubMed
10. Ben-Soussan E, Savoye G, Antonietti M, Ramirez S, Ducrotté P, Lerebours E. Is a 2-liter PEG preparation useful before capsule endoscopy? J Clin Gastroenterol 2005;39:381–384.Article PubMed
11. Ladas SD, Triantafyllou K, Spada C, et al. European Society of Gastrointestinal Endoscopy (ESGE): recommendations (2009) on clinical use of video capsule endoscopy to investigate small-bowel, esophageal and colonic diseases. Endoscopy 2010;42:220–227.Article PubMed
12. Rokkas T, Papaxoinis K, Triantafyllou K, Pistiolas D, Ladas SD. Does purgative preparation influence the diagnostic yield of small bowel video capsule endoscopy? A meta-analysis. Am J Gastroenterol 2009;104:219–227.Article PubMed
13. Kantianis A, Karagiannis S, Liatsos C, et al. Comparison of two schemes of small bowel preparation for capsule endoscopy with polyethylene glycol: a prospective, randomized single-blind study. Eur J Gastroenterol Hepatol 2009;21:1140–1144.Article PubMed
14. Wu L, Cao Y, Liao C, Huang J, Gao F. Systematic review and meta-analysis of randomized controlled trials of Simethicone for gastrointestinal endoscopic visibility. Scand J Gastroenterol 2011;46:227–235.Article PubMed
15. Fang YH, Chen CX, Zhang BL. Effect of small bowel preparation with simethicone on capsule endoscopy. J Zhejiang Univ Sci B 2009;10:46–51.Article PubMed PMC
16. Ge ZZ, Chen HY, Gao YJ, Hu YB, Xiao SD. The role of simeticone in small-bowel preparation for capsule endoscopy. Endoscopy 2006;38:836–840.Article PubMed
17. Albert J, Göbel CM, Lesske J, Lotterer E, Nietsch H, Fleig WE. Simethicone for small bowel preparation for capsule endoscopy: a systematic, single-blinded, controlled study. Gastrointest Endosc 2004;59:487–491.Article PubMed
18. Wei W, Ge ZZ, Lu H, Gao YJ, Hu YB, Xiao SD. Purgative bowel cleansing combined with simethicone improves capsule endoscopy imaging. Am J Gastroenterol 2008;103:77–82.Article PubMed
19. Spada C, Riccioni ME, Familiari P, et al. Polyethylene glycol plus simethicone in small-bowel preparation for capsule endoscopy. Dig Liver Dis 2010;42:365–370.Article PubMed
20. Pennazio M, Santucci R, Rondonotti E, et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology 2004;126:643–653.Article PubMed
21. Almeida N, Figueiredo P, Freire P, et al. The effect of metoclopramide in capsule enteroscopy. Dig Dis Sci 2010;55:153–157.Article PubMed
22. Postgate A, Tekkis P, Patterson N, Fitzpatrick A, Bassett P, Fraser C. Are bowel purgatives and prokinetics useful for small-bowel capsule endoscopy? A prospective randomized controlled study. Gastrointest Endosc 2009;69:1120–1128.Article PubMed
23. Selby W. Complete small-bowel transit in patients undergoing capsule endoscopy: determining factors and improvement with metoclopramide. Gastrointest Endosc 2005;61:80–85.Article PubMed
24. Caddy GR, Moran L, Chong AK, Miller AM, Taylor AC, Desmond PV. The effect of erythromycin on video capsule endoscopy intestinal-transit time. Gastrointest Endosc 2006;63:262–266.Article PubMed
25. Leung WK, Chan FK, Fung SS, Wong MY, Sung JJ. Effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy. World J Gastroenterol 2005;11:4865–4868.Article PubMed PMC
26. Niv E, Bonger I, Barkay O, et al. Effect of erythromycin on image quality and transit time of capsule endoscopy: a two-center study. World J Gastroenterol 2008;14:2561–2565.Article PubMed PMC
27. Wei W, Ge ZZ, Lu H, Gao YJ, Hu YB, Xiao SD. Effect of mosapride on gastrointestinal transit time and diagnostic yield of capsule endoscopy. J Gastroenterol Hepatol 2007;22:1605–1608.Article PubMed
28. Hooks SB 3rd, Rutland TJ, Di Palma JA. Lubiprostone neither decreases gastric and small-bowel transit time nor improves visualization of small bowel for capsule endoscopy: a double-blind, placebo-controlled study. Gastrointest Endosc 2009;70:942–946.Article PubMed

Fig. 1

Meta-analysis of randomized controlled trials on the effect of using polyethylene glycol (PEG) solution for bowel preparation on the small bowel visualization quality of video capsule endoscopy. CI, confidence interval.

Fig. 2

Meta-analysis of randomized controlled trials on the effect of using polyethylene glycol (PEG) solution for bowel preparation on the diagnostic yield of video capsule endoscopy. CI, confidence interval.

Fig. 3

Meta-analysis of randomized controlled trials on the effect of using polyethylene glycol (PEG) solution for bowel preparation on the completion rate of video capsule endoscopy. CI, confidence interval.

Fig. 4

Meta-analysis of randomized controlled trials on the effects of using polyethylene glycol (PEG) 2 L vs. 4 L solution for bowel preparation on the diagnostic yield of video capsule endoscopy. CI, confidence interval.

Fig. 5

Meta-analysis of randomized controlled trials on the effects of using polyethylene glycol (PEG) 2 L vs. 4 L solution for bowel preparation on the completion rate of video capsule endoscopy. CI, confidence interval.

Fig. 6

Meta-analysis of randomized controlled trials on the effects of fasting or polyethylene glycol solution plus simethicone vs. clear liquid diet for the small bowel visualization quality of video capsule endoscopy. CI, confidence interval.

Fig. 7

Meta-analysis of randomized controlled trials on the effects of fasting or polyethylene glycol solution plus simethicone vs. clear liquid diet for bowel preparation on the completion rate of video capsule endoscopy. CI, confidence interval.

Fig. 8

Meta-analysis of randomized controlled trials on the effects of using prokinetics on the diagnostic yield of video capsule endoscopy. CI, confidence interval.

Fig. 9

Meta-analysis of randomized controlled trials on the effects of using prokinetics on the completion rate of video capsule endoscopy. CI, confidence interval.

Table 1

Quality of Evidence and Strength of a Recommendation

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

Consenso de endoscopia en enfermedad inflamatoria intestinal de la Organización Panamericana de Crohn y Colitis (PANCCO) y la Sociedad Interamericana de endoscopia (SIED)
Viviana Parra-Izquierdo, Fabio Leonel Gil-Parada, Fabian Juliao-Baños, Carolina Pavez-Ovalle, William Otero-Regino, Juan Sebastian Frías-Ordoñez, Asadur Tchekmedyian, Juan Eloy Paredes Mendez, Rodrigo Dorelo, Kenneth Ernest-Suarez, Marcos Leites Madera, M
Revista de Gastroenterología del Perú.2024;[Epub] CrossRef
Small Bowel Capsule Endoscopy within 6 Hours Following Bowel Preparation with Polyethylene Glycol Shows Improved Small Bowel Visibility
Chang Wan Choi, So Jung Lee, Sung Noh Hong, Eun Ran Kim, Dong Kyung Chang, Young-Ho Kim, Yun Jeong Lim, Ki-Nam Shim, Hyun-Seok Lee
Diagnostics.2023; 13(3): 469. CrossRef
Design of a Convolutional Neural Network as a Deep Learning Tool for the Automatic Classification of Small-Bowel Cleansing in Capsule Endoscopy
Tiago Ribeiro, Miguel José Mascarenhas Saraiva, João Afonso, Pedro Cardoso, Francisco Mendes, Miguel Martins, Ana Patrícia Andrade, Hélder Cardoso, Miguel Mascarenhas Saraiva, João Ferreira, Guilherme Macedo
Medicina.2023; 59(4): 810. CrossRef
A systematic review on diagnosis and treatment of gastrointestinal diseases by magnetically controlled capsule endoscopy and artificial intelligence
Xiaotong Wang, Xiaoming Hu, Yongxue Xu, Jiahao Yong, Xiang Li, Kaixuan Zhang, Tao Gan, Jinlin Yang, Nini Rao
Therapeutic Advances in Gastroenterology.2023;[Epub] CrossRef
Research on driving force of capsule endoscope in fluid
Zhifan Teng, Jianhua Liu, Hongbo Sun, Quanyue Liu, Yujia Zhai, Qiuliang Wang
Archive of Applied Mechanics.2023; 93(12): 4387. CrossRef
AI-Driven Colon Cleansing Evaluation in Capsule Endoscopy: A Deep Learning Approach
Miguel José Mascarenhas Saraiva, João Afonso, Tiago Ribeiro, Pedro Cardoso, Francisco Mendes, Miguel Martins, Ana Patrícia Andrade, Hélder Cardoso, Miguel Mascarenhas Saraiva, João Ferreira, Guilherme Macedo
Diagnostics.2023; 13(23): 3494. CrossRef
Evaluation by a Machine Learning System of Two Preparations for Small Bowel Capsule Endoscopy: The BUBS (Burst Unpleasant Bubbles with Simethicone) Study
Charles Houdeville, Romain Leenhardt, Marc Souchaud, Guillaume Velut, Nicolas Carbonell, Isabelle Nion-Larmurier, Alexandre Nuzzo, Aymeric Histace, Philippe Marteau, Xavier Dray
Journal of Clinical Medicine.2022; 11(10): 2822. CrossRef
Application of capsule endoscopy in patients with chronic and recurrent abdominal pain
Wei Yang, Zheng Li, Rui Liu, Xudong Tong, Wei Wang, Dongqiang Xu, Shan Gao
Medical Engineering & Physics.2022; 110: 103901. CrossRef
Lavage, Simethicone, and Prokinetics—What to Swallow with a Video Capsule
Martin Keuchel, Niehls Kurniawan, Marc Bota, Peter Baltes
Diagnostics.2021; 11(9): 1711. CrossRef
Benefit of Capsule Endoscopy in the Setting of Iron Deficiency Anemia in Patients Above Age 65
Joseph G Lee, Cherry Galorport, Jordan Yonge, Robert A Enns
Journal of the Canadian Association of Gastroenterology.2020; 3(1): 36. CrossRef
Optimal Bowel Preparation for Capsule Endoscopy and Device-assisted Enteroscopy
Hyun Joo Song
The Korean Journal of Gastroenterology.2020; 75(2): 74. CrossRef
The Efficacy of 4 Liters of Clear Liquids for Small Bowel Preparation Prior to Video Capsule Endoscopy
Nicholas Placone, Runalia Bahar, Surinder Mann
Clinical Endoscopy.2020; 53(6): 713. CrossRef
Ideal Method for Small Bowel Preparation before Video Capsule Endoscopy
Jun Lee, Shai Friedland
Clinical Endoscopy.2020; 53(6): 631. CrossRef
Capsule endoscopy for small‐intestinal disorders: Current status
Naoki Hosoe, Kaoru Takabayashi, Haruhiko Ogata, Takanori Kanai
Digestive Endoscopy.2019; 31(5): 498. CrossRef
Performance measures for small‐bowel endoscopy: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative
Cristiano Spada, Deirdre McNamara, Edward J Despott, Samuel Adler, Brooks D Cash, Ignacio Fernández-Urién, Hrvoje Ivekovic, Martin Keuchel, Mark McAlindon, Jean-Christophe Saurin, Simon Panter, Cristina Bellisario, Silvia Minozzi, Carlo Senore, Cathy Benn
United European Gastroenterology Journal.2019; 7(5): 614. CrossRef
Diagnostic Benefit of Simultaneous Capsule Endoscopy Using Two Different Systems
Seung Han Kim, Hyuk Soon Choi, Hoon Jai Chun, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim
Gastroenterology Research and Practice.2018; 2018: 1. CrossRef
Predictive factors of an incomplete examination and inadequate small-bowel cleanliness during capsule endoscopy
Ana Ponte, Rolando Pinho, Adélia Rodrigues, Joana Silva, Jaime Rodrigues, Mafalda Sousa, Jo�o Carvalho
Revista Española de Enfermedades Digestivas.2018;[Epub] CrossRef
Neoplastic Diseases of the Small Bowel
Emanuele Rondonotti, Anastasios Koulaouzidis, Diana E. Yung, Surekha N. Reddy, Julius Georgiou, Marco Pennazio
Gastrointestinal Endoscopy Clinics of North America.2017; 27(1): 93. CrossRef
Quand et comment utiliser la vidéocapsule endoscopique de l’intestin grêle chez l’enfant ?
J. Viala, L. Michaud, M. Bellaiche, A. Lachaux
Archives de Pédiatrie.2017; 24(4): 391. CrossRef
Quality Indicators for Small Bowel Capsule Endoscopy
Ki-Nam Shim, Seong Ran Jeon, Hyun Joo Jang, Jinsu Kim, Yun Jeong Lim, Kyeong Ok Kim, Hyun Joo Song, Hyun Seok Lee, Jae Jun Park, Ji Hyun Kim, Jaeyoung Chun, Soo Jung Park, Dong-Hoon Yang, Yang Won Min, Bora Keum, Bo-In Lee
Clinical Endoscopy.2017; 50(2): 148. CrossRef
Optimal use of polyethylene glycol for preparation of small bowel video capsule endoscopy: a network meta-analysis
Shan Wu, Yun-Jie Gao, Zhi-Zheng Ge
Current Medical Research and Opinion.2017; 33(6): 1149. CrossRef
Systematic review and meta-analysis: is bowel preparation still necessary in small bowel capsule endoscopy?
Diana E. Yung, Emanuele Rondonotti, Catherine Sykes, Marco Pennazio, John N. Plevris, Anastastios Koulaouzidis
Expert Review of Gastroenterology & Hepatology.2017; 11(10): 979. CrossRef
Optimal Bowel Preparation for Video Capsule Endoscopy
Hyun Joo Song, Jeong Seop Moon, Ki-Nam Shim
Gastroenterology Research and Practice.2016; 2016: 1. CrossRef
Clinical Experience with the PillCam Patency Capsule prior to Video Capsule Endoscopy: A Real-World Experience
C. Römmele, J. Brueckner, H. Messmann, S. K. Gölder
Gastroenterology Research and Practice.2016; 2016: 1. CrossRef
Indications et techniques de la vidéocapsule endoscopique de l’intestin grêle chez l’enfant
Alain Lachaux
Acta Endoscopica.2016; 46(1-2): 63. CrossRef
Current status and future perspectives of capsule endoscopy
Hyun Joo Song, Ki-Nam Shim
Intestinal Research.2016; 14(1): 21. CrossRef
Validated computed cleansing score for video capsule endoscopy
Amir Klein, Moshe Gizbar, Michael J Bourke, Golo Ahlenstiel
Digestive Endoscopy.2016; 28(5): 564. CrossRef
The Use of Domperidone Increases the Completion Rate of Small Bowel Capsule Endoscopy
Anastasios Koulaouzidis, Stavros Dimitriadis, Sarah Douglas, John N. Plevris
Journal of Clinical Gastroenterology.2015; 49(5): 395. CrossRef
What Is the Optimal Timing of Bowel Preparation for Video Capsule Endoscopy?
Hyun Joo Song, Ki-Nam Shim
Clinical Endoscopy.2015; 48(3): 183. CrossRef
A Single-Center Randomized Controlled Trial Evaluating Timing of Preparation for Capsule Enteroscopy
Katherine R. Black, Wiley Truss, Cynthia I. Joiner, Shajan Peter, Frederick H. Weber
Clinical Endoscopy.2015; 48(3): 234. CrossRef
Guideline for wireless capsule endoscopy in children and adolescents: A consensus document by the SEGHNP (Spanish Society for Pediatric Gastroenterology, Hepatology, and Nutrition) and the SEPD (Spanish Spanish Society for Digestive Diseases)
Federico Argüelles Arias, Ester Donat, Ignacio Fernández-Urien, Fernando Alberca, Federico Argüelles-Martín, María José Martínez, Manuel Molina, Vicente Varea, Juan Manuel Herrerías Gutiérrez, Carmen Ribes-Koninckx
Revista Española de Enfermedades Digestivas.2015;[Epub] CrossRef
Rentabilidad de la cápsula endoscópica en mujeres premenopáusicas con anemia ferropénica
Carmen Garrido Durán, Eduardo Iyo Miyashiro, Claudia Páez Cumpa, Sam Khorrami Minaei, Alicia Erimeiku Barahona, Alfredo Llompart Rigo
Gastroenterología y Hepatología.2015; 38(6): 373. CrossRef
Practical aspects of delivering a small bowel endoscopy service in the UK
Melissa F Hale, Carolyn Davison, Simon Panter, Kaye Drew, David S Sanders, Reena Sidhu, Mark E McAlindon
Frontline Gastroenterology.2015; 6(2): 132. CrossRef
Effect of longer battery life on small bowel capsule endoscopy
George Ou
World Journal of Gastroenterology.2015; 21(9): 2677. CrossRef
Video capsule endoscopy: Perspectives of a revolutionary technique
Simon Bouchard
World Journal of Gastroenterology.2014; 20(46): 17330. CrossRef
Capsule endoscopy: Present status and future expectation
Mahesh K Goenka
World Journal of Gastroenterology.2014; 20(29): 10024. CrossRef
Do prokinetics influence the completion rate in small-bowel capsule endoscopy? A systematic review and meta-analysis
Anastasios Koulaouzidis, Andry Giannakou, Diana E. Yung, Konstantinos J. Dabos, John N. Plevris
Current Medical Research and Opinion.2013; 29(9): 1171. CrossRef

PubReader
ePub Link

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Guidelines for Bowel Preparation before Video Capsule Endoscopy

Clin Endosc. 2013;46(2):147-154. Published online March 31, 2013

DOI: https://doi.org/10.5946/ce.2013.46.2.147

XML Download

Figure

Guidelines for Bowel Preparation before Video Capsule Endoscopy

Fig. 1 Meta-analysis of randomized controlled trials on the effect of using polyethylene glycol (PEG) solution for bowel preparation on the small bowel visualization quality of video capsule endoscopy. CI, confidence interval.

Fig. 2 Meta-analysis of randomized controlled trials on the effect of using polyethylene glycol (PEG) solution for bowel preparation on the diagnostic yield of video capsule endoscopy. CI, confidence interval.

Fig. 3 Meta-analysis of randomized controlled trials on the effect of using polyethylene glycol (PEG) solution for bowel preparation on the completion rate of video capsule endoscopy. CI, confidence interval.

Fig. 4 Meta-analysis of randomized controlled trials on the effects of using polyethylene glycol (PEG) 2 L vs. 4 L solution for bowel preparation on the diagnostic yield of video capsule endoscopy. CI, confidence interval.

Fig. 5 Meta-analysis of randomized controlled trials on the effects of using polyethylene glycol (PEG) 2 L vs. 4 L solution for bowel preparation on the completion rate of video capsule endoscopy. CI, confidence interval.

Fig. 6 Meta-analysis of randomized controlled trials on the effects of fasting or polyethylene glycol solution plus simethicone vs. clear liquid diet for the small bowel visualization quality of video capsule endoscopy. CI, confidence interval.

Fig. 7 Meta-analysis of randomized controlled trials on the effects of fasting or polyethylene glycol solution plus simethicone vs. clear liquid diet for bowel preparation on the completion rate of video capsule endoscopy. CI, confidence interval.

Fig. 8 Meta-analysis of randomized controlled trials on the effects of using prokinetics on the diagnostic yield of video capsule endoscopy. CI, confidence interval.

Fig. 9 Meta-analysis of randomized controlled trials on the effects of using prokinetics on the completion rate of video capsule endoscopy. CI, confidence interval.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Guidelines for Bowel Preparation before Video Capsule Endoscopy

Table 1

Quality of Evidence and Strength of a Recommendation

Table 1 Quality of Evidence and Strength of a Recommendation