Low-dose and same day use of polyethylene glycol improves image of video capsule endoscopy: A multi-center randomized clinical trial.

Abstract

Clear visualization of the small bowel is a requirement for satisfactory video capsule endoscopy (VCE). The aim of this study was to identify the optimal dose and timing of polyethylene glycol (PEG) for small bowel preparation before VCE. A total of 410 patients were enrolled in this prospective randomized trial. All patients fasted for 12h and ingested 320mg simethicone 30min before swallowing the capsule. Patients were randomized into five groups: Group A (no PEG), Group B (1-L PEG, 12h before VCE), Group C (2-L PEG, 12h before VCE), Group D (1-L PEG, 4h before VCE), and Group E (2-L PEG, 4h before VCE). The primary endpoint was small bowel visualization quality (SBVQ), and the secondary endpoints were patient acceptability and diagnosis rate of VCE. Excellent SBVQ was achieved in 27 (32.5%) of Group A, 38 (46.3%) of Group B, 40 (48.2%) of Group C, 55 (66.3%) of Group D, and 43 (54.4%) of Group E. The percentage of excellent SBVQ in Group D was significantly more than in Group A (66.3% vs 32.5%, P<0.001), and diagnostic rate in the distal segment was higher (28.9% vs 10.8%, P=0.0035). Patient acceptance of 1-L PEG was better than of 2-L PEG (P<0.005). Small bowel cleansing with 1-L PEG given 4h before VCE was the optimal preparation for visualization of the bowel and patient acceptance (ClinicalTrials.gov, ID: NCT02486536).