To evaluate the effects of the various methods of small bowel preparation on the quality of visualization of the small bowel and the gastrointestinal transit time of capsule endoscopy (CE).
Ninety patients referred for CE were prospectively randomized to three equal groups according to the preparation used: (a) a control group, in which patients were requested to drink 1 L of clear liquids only, 12 h before the examination; (b) a purgative group, in which patients were requested to ingest 1 L of a polyethylene glycol (PEG)/electrolyte solution only, 12 h before the examination; or (c) a purgative combined with simethicone group (P-S group), in which patients were requested to ingest 1 L of PEG, 12 h before the examination, and 300 mg of simethicone, 20 min before the examination. Effects of the different bowel preparations on the gastric transit time (GTT), small bowel transit time (SBTT), examination completion rate, quality of images of the entire small intestine, and cleansing of the proximal small bowel and distal ileum were evaluated.
The number of patients with “adequate” cleansing of the entire small intestine was 17 in the P-S group, 12 in the purgative group, and seven in the control group (P= 0.002). The P-S group had significantly better image quality than the control group (P= 0.001). The P-S group had significantly better image quality for the proximal small bowel (segment A [Seg A]) than the control group (P= 0.0001). Both the P-S group (P= 0.0001) and the purgative group (P= 0.0002) had significantly better image quality for the distal ileum (segment B [Seg B]) than the control group; the P-S group had significantly better image quality than the purgative group as well (P= 0.0121). Gastrointestinal transit time was not different among the three groups, nor was the examination completion rate.
Purgative bowel cleansing combined with simethicone before CE improved the quality of imaging of the entire small bowel as well as the visualization of the mucosa in the proximal and distal small intestine.
Department of Gastroenterology, Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Reprint requests and correspondence: Zhi-Zheng Ge, M.D., Department of Gastroenterology, Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai Jiao Tong University School of Medicine, 145 Shan Dong Zhong Road, Shanghai, 200001, P.R. China.
Received May 20, 2007; accepted July 24, 2007.
CONFLICT OF INTERESTGuarantor of the article: Zhi-Zheng Ge, M.D.
Specific author contributions: Dr. Wei Wei participated in designing the study, took responsibility for patient selection, analyzed data, and wrote the article. Prof. Zhi-Zheng Ge was the chief designer of the study and took charge of reading all the CE images. Mrs. Yun-Jie Gao did all the preparations before CE, monitored the procedures, and downloaded the recorded images to the workstation. Prof. Hong Lu, Prof. Yun-Biao Hu, and Prof. Shu-Dong Xiao helped to design the study and analyze the results.
Financial support: Supported by grants from Shanghai Leading Academic Discipline Project (Number: Y0205) to Zhi-Zheng Ge.
Potential competing interests: None.