Assessment of Efficacy and Tolerance of Three Solutions for Small Bowel Preparation for Video Capsule Endoscopy

Abstract

Introduction: Wireless video capsule endoscopy (VCE) is a useful noninvasive method for visual examination of small bowel mucosa with indications including obscure gastrointestinal bleeding, iron deficiency anemia, Crohn's disease, and small bowel tumors. One of the short-comings of VCE, however, is poor visualization of mucosa due to enteric secretions and bubbles obscuring the image. There is a great deal of debate about the appropriate preparation for VCE. Despite the current studies and recommendations, there has been no clear recommendation as to the best mode of small bowel preparation for VCE. Studies have also yet to investigate the use of sodium picosulfate, magnesium oxide, and anhydrous citric acid (Prepopik), as it has showed favorable patient satisfaction and improved visualization in colonoscopies. Methods: Thirty-nine patients who met exclusion and inclusion criteria (Figure 1) were randomized into 3 preparation groups: clear liquid diet (CLD), 10oz of magnesium citrate (MC), and one packet of Prepopik followed by 12oz of clear liquid (full colonoscopy dose is 2 packets). Thirty-five patients completed the study with one patient excluded because the capsule was retained in the stomach. Patients completed a questionnaire the morning after the preparation to analyze tolerability. The endocopists were blinded from the study and completed a form regarding the preparation quality. The non-parametric Kruskal Wallis Test was used to analyze the questionnaires.Figure 1Results: No statistically significant difference in the quality of preparations both qualitative (Table 1) and quantitative was found. Prepopik had a mean of 19% (9.4) of images obscured; MC had 22.9% (10.8), and CLD had 23.6% (7.5), p-value = 0.506. There was also no significant difference in patient tolerability (Table 2) and capsule transit time amongst the three preparation groups. The means for tolerability were 4.0 (0.9), 4.0 (1.1), and 4.6 (0.7) for Prepopik, MC, and CLD respectively, p = 0.134. Furthermore, the mean capsule transit times were again respectively 4.45 (1.5), 4.29 (1.3), and 3.94 (1.4), p = 0.56.Figure 2Figure 3Conclusion: Prepopik is a well-tolerated low volume colon preparation which can potentially be used to improve visualization of gastric mucosa on VCE. Although a statistically significant difference was not observed with this study, a larger sample size, or use in selected patients expected to have poor mucosal visualization may yield significance.