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Gastrointest Endosc. 2009 May;69(6):1120-8. doi: 10.1016/j.gie.2008.06.044. Epub 2009 Jan 18.

Are bowel purgatives and prokinetics useful for small-bowel capsule endoscopy? A prospective randomized controlled study.

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  • 1Wolfson Unit for Endoscopy, St. Mark's Hospital, Imperial College London, UK. apostgate@yahoo.com

Abstract

BACKGROUND:

Capsule endoscopy (CE) is limited by incomplete small-bowel transit and poor view quality in the distal bowel. Currently, there is no consensus regarding the use of bowel purgatives or prokinetics in CE.

OBJECTIVE:

To evaluate the usefulness of bowel purgatives and prokinetics in small-bowel CE.

DESIGN:

Prospective single-blind randomized controlled study.

SETTING:

Academic endoscopy unit.

PATIENTS:

A total of 150 patients prospectively recruited.

INTERVENTION:

Patients were randomized to 1 of 4 preparations: "standard" (fluid restriction then nothing by mouth 12 hours before the procedure, water and simethicone at capsule ingestion [S]); "standard" + 10 mg oral metoclopramide before the procedure (M); Citramag + senna bowel-purgative regimen the evening before CE (CS); Citramag + senna + 10 mg metoclopramide before the procedure (CSM).

MAIN OUTCOME MEASUREMENTS:

Gastric transit time (GTT) and small-bowel transit time (SBTT), completion rates (CR), view quality, and patient acceptability.

SECONDARY OUTCOME MEASURES:

positive findings, diagnostic yield.

RESULTS:

No significant difference was noted among groups for GTT (median [minutes] M, CS, and CSM vs S: 17.3, 24.7, and 15.1 minutes vs 16.8 minutes, respectively; P = .62, .18, and .30, respectively), SBTT (median [minutes] M, CS, and CSM vs S: 260, 241, and 201 vs 278, respectively; P = .91, .81, and .32, respectively), or CRs (85%, 85%, and 88% vs 89% for M, CS, and CSM vs S, respectively; P = .74, .74, and 1.00, respectively). There was no significant difference in view quality among groups (of 44: 38, 37, and 40 vs 37 for M, CS, and CSM, vs S, respectively; P = .18, .62, and .12, respectively). Diagnostic yield was similar among the groups. CS and CSM regimens were significantly less convenient (P < .001), and CS was significantly less comfortable (P = .001) than standard preparation.

CONCLUSIONS:

Bowel purgatives and prokinetics do not improve CRs or view quality at CE, and bowel purgatives reduce patient acceptability.

PMID:
19152909
[PubMed - indexed for MEDLINE]
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