Should We Be Using Bowel Preparation and Prokinetic Agents for Small Bowel Capsule Endoscopy? A Prospective Randomized Controlled Trial

Abstract

randomized to PEG, OSPS, or dual (OSPSþPEG) preparations. Subjects with GFR %60 ml/min were not randomized to OSPS or dual preparation. Blood and early morning spot urine were collected 1 wk prior to (v1), on day of (v2) and 1 wk after C (v3) for serum creatinine (Cr, mg/dL), estimated glomerular filtration rate (eGFR, ml/min), phosphorous (P, mg/dL), calcium (Ca, mg/dL) with urinary P, creatinine, and N-acetyl-Dglucosaminidase (NAG, IU/mg of creatinine), a lysosomal enzyme released in urine after tubular injury. Effect on renal function was assessed by absolute change in Cr, percent change in Cr and eGFR at v2 and v3 compared to v1. Results: A total of 165 subjects (AB Z 139; mean age: 58 1 y and SCI Z 26; mean age: 60 2y; p Z 0.3) were analyzed. Bowel preparation was achieved with PEG in 55 (AB Z 47; SCI Z 8), OSPS in 55 (AB Z 47; SCI Z 8), and dual in 56 (AB Z 46; SCI Z 10) subjects. In AB subjects, Cr at v2 increased with OSPS (0.9 0.2 to 0.94 0.3) and dual (0.9 0.2 to 0.91 0.2) preparation, but decreased in SCI subjects (0.7 0.2 to 0.6 0.2) and returned to baseline by v3. Absolute change in Cr at v2 was higher in AB subjects compared to SCI with OSPS (0.01 0.02 vs -0.09 0.03, p ! 0.04) and dual (0.04 0.03 vs. -0.1 0.05, p ! 0.07). Percent change in Cr was higher with OSPS (2.1 2.2 vs -12 4.6, p ! 0.01) and dual (4 3.4 vs. -12 6.3, p ! 0.03) but not with PEG (2.1 2.2 vs. -12 4.5, p O 0.1). Changes in eGFR paralleled Cr changes. In AB subjects, OSPS increased serum P (3.2 0.5 to 5.7 1.7, p ! 0.0001), urinary P (67 6 to 405 40, p ! 0.0001), urinary NAG (0.4 0.05 to 0.6 0.1, p ! 0.02) and decreased serum Ca (9.2 0.4 to 8.8 8.8 0.4m p ! 0.0005) at v2. Similar trends were seen with dual but not with PEG. With OSPS in SCI subjects, changes in serum P (increase) and Ca (decrease) were similar to AB subjects without significant change in urinary P or NAG. Conclusion: Ingestion of OSPS alone or in combination with PEG resulted in elevation of serum P with decrease in Ca in AB and SCI subjects. Transient, but clinically insignificant, deterioration of renal function occurs in AB subjects. SCI subjects are less predisposed to this toxicity of OSPS and use of OSPS appears to be safe for routine C in them.