Colonic cleansing before colon capsule endoscopy (CCE) – tolerable and effective?

Abstract

Introduction: Recent studies with CCE demonstrated an excellent sensitivity in colorectal polyp detection compared to standard colonoscopy (89%) in a subgroup of patients (pts) with optimal colonic preparation. In contrast, in up to 18% of all pts the colonic cleansing is still ineffective to visualize the entire colonic mucosa with CCE. The aim of the present study was to retrospectively evaluate the colon cleanliness in our CCE pts. Patients and Methods: We investigated 28 pts (11 female, 17 male, mean age: 49.6 years) with CCE. All pts filled a standardized questionnaire about their defecation habits. We applied a standardized preparation protocol as follows: low fiber diet, 45ml Fleet Phosphosoda two days before, and a liquid diet combined with 3 liters of PEG one day before the CCE study. For the assessment of colonic cleanliness the modified Boston bowel preparation scale (BBPS) had been applied (graded as 0: poor; 1: incomplett; 2: good; and 3: excellent preparation) in four different colonic regions. Each of the CCE recordings was evaluated by two independent observers. Results: We found excellent inter-observer agreement of the BBPS. The mean of the BBPS from each bowel segments determined as follows: coecum 1.11, transverse colon 2.29, descending and sigmoid colon 2.39, rectum 1.89. The mean of the overall BBPS scores calculated from all four segments was 7.88. Inadequate colonic preparation (BBPS score under 6) had been documented in 17.9% of our pts. Regional BBPS scores indicated a significantly better mucosal visualization in the transverse colon and the descending plus sigmoid colon (p=5.4×10–8) versus in the coecum and the rectum. The polyp detection rate did not correlated with BBPS (p=0.36). In contrast, a significant correlation could be demonstrated between the defecation habits and the overall BBPS (p=0.02). Conclusion: Current protocols of bowel preparation for CCE are suboptimal. Individual bowel cleansing with different laxatives or increased volume of PEG with different timing of administration might be necessary to overcome these difficulties.