Abstract
The development of new capsules now allows endoscopic diagnosis in all segments of the gastrointestinal tract and comes with new needs for differentiated preparation regimens. Although the literature is steadily increasing, the results of the conducted trials on preparation are sometimes conflicting. The ingestion of simethicone before gastric and small bowel capsule endoscopy for prevention of air bubbles is established. The value of a lavage before small bowel capsule endoscopy (SBCE) is recommended, although not supported by all studies. Ingestion in the morning before the procedure seems useful for the improvement of mucosa visualization. Lavage after swallowing of the capsule seems to improve image quality, and in some studies also diagnostic yield. Prokinetics has been used with first generation capsules to shorten gastric transit time and increase the rate of complete small bowel visualization. With the massively prolonged battery capacity of the new generation small bowel capsules, prokinetics are only necessary in significantly delayed gastric emptying as documented by a real-time viewer. Lavage is crucial for an effective colon capsule or pan-intestinal capsule endoscopy. Mainly high or low volume polyethylene glycol (PEG) is used. Apart from achieving optimal cleanliness, propulsion of the capsule by ingested boosts is required to obtain a complete passage through the colon within the battery lifetime. Boosts with low volume sodium picosulfate (NaP) or diatrizoate (gastrografin) seem most effective, but potentially have more side effects than PEG. Future research is needed for more patient friendly but effective preparations, especially for colon capsule and pan-intestinal capsule endoscopy.
Highlights
Since the advent of video capsule endoscopy in 2000, a steady development of hardware, software, procedure, and indication took place
Preceding lavage is only necessary if gastric capsule endoscopy is combined with a small bowel procedure once the capsule has been directed into the descending duodenum
An increased rate of complete small bowel investigation after 10 mg of MCP had been described for PillCam SB1 in a group of 67 patients compared to a historic cohort of 80 patients
Summary
Since the advent of video capsule endoscopy in 2000, a steady development of hardware, software, procedure, and indication took place. Non-invasive video capsule endoscopy is limited by its passive propulsion and inability to clean or distend the GI lumen. Various types of bowel preparation have been implemented to increase mucosa visualization and prokinetics were applied to improve complete visualization of the small bowel. New generations of capsules with longer battery time and higher resolution have shifted the focus from incomplete small bowel visualization to optimal cleanliness. Introducing new types of capsules for the esophagus, stomach, colon, or entire GI tract has created very different needs for preparation of the GI tract to allow best visualization of the mucosa of each organ. This paper reviews the aspects of preparation for the different capsule endoscopies of esophagus, stomach, small bowel, and colon using lavage, anti-foaming agents, and prokinetic drugs. Some of the scores used for assessment of their effect are described
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