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Small Bowel Capsule Endoscopy within 6 Hours Following Bowel Preparation with Polyethylene Glycol Shows Improved Small Bowel Visibility. Diagnostics (Basel) 2023; 13:diagnostics13030469. [PMID: 36766574 PMCID: PMC9914394 DOI: 10.3390/diagnostics13030469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Although bowel preparation influences small bowel visibility for small bowel capsule endoscopy (SBCE), the optimal timing for bowel preparation has not been established yet. Thus, the aim of the study was to evaluate the optimal timing of polyethylene glycol (PEG) for small bowel preparation before SBCE. This multicenter prospective observational study was conducted on patients who underwent SBCE following bowel preparation with polyethylene glycol (PEG). Patients were categorized into three groups according to the time used for completing PEG ingestion: group A, within 6 h; group B, 6-12 h; and group C, over 12 h. The percentage of unclean segment in small bowel (unclean image duration / small bowel transit time × 100) and small bowel visibility quality (SBVQ) were evaluated according to the time interval between the last ingestion of PEG and swallowing of small bowel capsule endoscope. A total of 90 patients were enrolled and categorized into group A (n = 40), group B (n = 27), and group C (n = 23). The percentage of unclean segment in the entire small bowel increased gradually from group A to C (6.6 ± 7.6% in group A, 11.3 ± 11.8% in group B, and 16.2 ± 10.7% in group C, p = 0.001), especially in the distal small bowel (11.4 ± 13.6% in group A, 20.7 ± 18.7% in group B, and 29.5 ± 16.4% in group C, p < 0.001). The proportion of patients with adequate SBVQ in group A was significantly (p < 0.001) higher (30/40, 75.0%) than that in group B (17/27, 63.0%) or group C (5/23, 21.7%). In multivariate analysis, group A was associated with an increased likelihood of adequate SBVQ compared with group C (odds ratio [OR]: 13.05; 95% confidence interval [CI]: 3.53-48.30, p < 0.001). Completing PEG ingestion within 6 h prior to SBCE could enhance small bowel visibility.
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Lamba M, Ryan K, Hwang J, Grimpen F, Lim G, Cornelius D, Moss A, Lim EJ, Brown G, Nguyen N, Tippett M, Taylor A, Appleyard M. Clinical utility of purgative bowel preparation before capsule endoscopy: a multicenter, blinded, randomized controlled trial. Gastrointest Endosc 2022; 96:822-828.e1. [PMID: 35843287 DOI: 10.1016/j.gie.2022.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Optimal bowel preparation before capsule endoscopy (CE) is currently unknown. In this multicenter, blinded, randomized controlled trial, we assessed clinical effectiveness of 2 types of purgative regimen and a control arm of clear fluid only. METHODS Patients with suspected small intestinal bleeding were randomized into 3 arms: arm A, clear fluids only for 18 hours before CE and simethicone 200 mg in 150 mL water immediately before CE; arm B, same as A + 2 L of polyethylene glycol (PEG) 12 hours before CE; and arm C, same as A + 1 L PEG + sodium ascorbate 3 hours before CE. To assess diagnostic yield, lesions were classified either as highly relevant (P2) or less relevant (P0 or P1) lesions. Small-bowel visualization quality (SBVQ) was assessed using the Brotz score. Patient tolerability was assessed using the visual analog scale (0-10, with lower scores indicating better tolerability). RESULTS Two hundred twenty-nine patients completed the study. The mean age was 58.7 years (95% confidence interval, 29.3-87.9), and 47.2% were men. There was no significant difference in diagnosis of P2 lesions in arms A, B, and C (48.7%, 48.0%, and 45.9%, respectively; P = .94). Overall SBVQ and distal SBVQ were similar across the 3 arms (P = .94 and P = .68, respectively). Patients reported better tolerability in arm A (mean score, 1.5) compared with arms B and C (mean score, 3.5 and 2.6, respectively; P < .001). CONCLUSIONS The use of a purgative bowel preparation before CE does not improve diagnostic yield or small-bowel visualization and is associated with lower patient tolerance. (Clinical trial registration number: ACTRN 12614000883617.).
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Affiliation(s)
- Mehul Lamba
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Kimberley Ryan
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jason Hwang
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Florian Grimpen
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Gary Lim
- Department of Gastroenterology and Hepatology, Canterbury District Health Board, Christchurch, New Zealand
| | - Dale Cornelius
- Department of Gastroenterology and Hepatology, Canterbury District Health Board, Christchurch, New Zealand
| | - Alan Moss
- Department of Gastroenterology and Hepatology, Western Health, Footscray, Victoria, Australia
| | - Eu Jin Lim
- Department of Gastroenterology and Hepatology, Western Health, Footscray, Victoria, Australia
| | - Gregor Brown
- Department of Gastroenterology and Hepatology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Nam Nguyen
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Marcus Tippett
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrew Taylor
- Department of Gastroenterology and Hepatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Mark Appleyard
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Alageeli M, Yan B, Alshankiti S, Al-Zahrani M, Bahreini Z, Dang TT, Friedland J, Gilani S, Homenauth R, Houle J, Kloc M, Luhoway J, Merotto L, Rofaiel R, Singh C, Smith A, Thomas B, Townsend C, Yoo D, Zepeda-Gomez S, Stitt L, Jairath V, Sey MSL. KODA score: an updated and validated bowel preparation scale for patients undergoing small bowel capsule endoscopy. Endosc Int Open 2020; 8:E1011-E1017. [PMID: 32743051 PMCID: PMC7373654 DOI: 10.1055/a-1176-9889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/01/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims A reliable outcome measure is needed for bowel preparation quality during capsule endoscopy. Currently, no scales are adequately validated. Our objective was to update an existing small bowel preparation score, create a standardized training module, then determine its inter-rater and intra-rater reliability. Patients and methods Modification to produce standardized scoring of an existing small bowel preparation score was performed followed by development of a training module and validation to create the new Korea-Canada (KODA) score. Twenty readers from a range of backgrounds, including capsule endoscopists, gastroenterology fellows, residents, medical students, and nurses rated bowel cleanliness in 25 capsule videos consisting of 1,233 images, in duplicate 4 weeks apart, after completing the training module. Sequential images selected in 5-minute intervals during small bowel transit were rated on a scale between 0-3 based on the amount of visualized mucosa and the degree of obstruction. Reliability was assessed using estimates of intraclass correlation coefficients (ICCs). Results Intraclass correlation coefficients for inter-rater (ICC 0.81, 95 % CI 0.70-0.87) and intra-rater (ICC 0.92, 95 % CI 0.87-0.94) reliability were almost perfect among the 20 readers. Inter-rater reliability ranged between 0.72 (95 % CI 0.57-0.81) and 0.89 (95 % CI 0.79-0.93) for nurses and residents, respectively. Intra-rater reliability was greater than 0.90 for all groups except for nurses, which was still almost perfect (ICC 0.86, 95 % CI 0.79-0.90). Conclusions Almost perfect inter-rater and intra-rater reliability was observed for the KODA score. This simple score could be used for future clinical trials after completion of the training module.
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Affiliation(s)
- Mohammad Alageeli
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Brian Yan
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Suliman Alshankiti
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - May Al-Zahrani
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Zoya Bahreini
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | | | - Joshua Friedland
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Syed Gilani
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Ravi Homenauth
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Milica Kloc
- London Health Sciences Centre, London, Ontario, Canada
| | - Jacqueline Luhoway
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Lucas Merotto
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Rymon Rofaiel
- Department of Medicine, London Health Sciences Center, London, Ontario, Canada
| | - Chantal Singh
- London Health Sciences Centre, London, Ontario, Canada
| | - Alexis Smith
- Arthur Labatt School of Nursing, Western University, London, Ontario, Canada
| | - Benson Thomas
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Cassandra Townsend
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - David Yoo
- Department of Medicine, London Health Sciences Center, London, Ontario, Canada
| | - Sergio Zepeda-Gomez
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Larry Stitt
- Robarts Clinical Trials Inc., London, Ontario, Canada
| | - Vipul Jairath
- Division of Gastroenterology, Western University, London, Ontario, Canada,Robarts Clinical Trials Inc., London, Ontario, Canada,Program for Experimental Medicine, Western University, London, Ontario, Canada,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Michael Sai Lai Sey
- Division of Gastroenterology, Western University, London, Ontario, Canada,Program for Experimental Medicine, Western University, London, Ontario, Canada
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Yung DE, Rondonotti E, Sykes C, Pennazio M, Plevris JN, Koulaouzidis A. Systematic review and meta-analysis: is bowel preparation still necessary in small bowel capsule endoscopy? Expert Rev Gastroenterol Hepatol 2017; 11:979-993. [PMID: 28737439 DOI: 10.1080/17474124.2017.1359540] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Optimal bowel preparation for small bowel capsule endoscopy(SBCE) is controversial. This meta-analysis aimed to investigate the effects of laxatives in SBCE. METHODS A comprehensive literature search was conducted for studies investigating the use of laxatives in SBCE. The primary outcome was diagnostic yield(DY) for SB findings; secondary outcomes SB visualization quality(SBVQ) and completion rate(CR). Pooled odds ratios(ORs) with 95% confidence intervals(CIs) and number needed to treat(NNT) were calculated. RESULTS Forty studies (4380 patients with laxatives, 2185 without) were included. Laxative use did not improve DY of SB findings overall (OR 1.11 (95%CI 0.85-1.44)) or for significant SB findings (OR 1.10 (95%CI 0.76-1.60)). However, SBVQ improved with the use of laxatives (OR 1.60 (95%CI 1.08-2.06)), NNT 14. The OR for completed SBCE was 1.30 (95%CI 0.95-1.78). Patients given polyethylene glycol(PEG) had lower DY than sodium phosphate(NaP). SBVQ improved more with NaP (NNT 7) than PEG (NNT 53). CONCLUSIONS Laxatives do not significantly improve DY or CR in SBCE, but do improve SBQV. The use of laxatives may be beneficial in patients likely to have subtle findings. There are significant differences in methodology/definitions between studies, hence the need for standardized visualization scoring and recording of SBCE findings.
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Affiliation(s)
- Diana E Yung
- a Centre for Liver & Digestive Disorders , The Royal Infirmary of Edinburgh , Edinburgh , UK
| | | | - Catherine Sykes
- a Centre for Liver & Digestive Disorders , The Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Marco Pennazio
- c Division of Gastroenterology U , San Giovanni AS University-Teaching Hospital , Torino , Italy
| | - John N Plevris
- a Centre for Liver & Digestive Disorders , The Royal Infirmary of Edinburgh , Edinburgh , UK
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Enns RA, Hookey L, Armstrong D, Bernstein CN, Heitman SJ, Teshima C, Leontiadis GI, Tse F, Sadowski D. Clinical Practice Guidelines for the Use of Video Capsule Endoscopy. Gastroenterology 2017; 152:497-514. [PMID: 28063287 DOI: 10.1053/j.gastro.2016.12.032] [Citation(s) in RCA: 269] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Video capsule endoscopy (CE) provides a noninvasive option to assess the small intestine, but its use with respect to endoscopic procedures and cross-sectional imaging varies widely. The aim of this consensus was to provide guidance on the appropriate use of CE in clinical practice. METHODS A systematic literature search identified studies on the use of CE in patients with Crohn's disease, celiac disease, gastrointestinal bleeding, and anemia. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. RESULTS The consensus includes 21 statements focused on the use of small-bowel CE and colon capsule endoscopy. CE was recommended for patients with suspected, known, or relapsed Crohn's disease when ileocolonoscopy and imaging studies were negative if it was imperative to know whether active Crohn's disease was present in the small bowel. It was not recommended in patients with chronic abdominal pain or diarrhea, in whom there was no evidence of abnormal biomarkers typically associated with Crohn's disease. CE was recommended to assess patients with celiac disease who have unexplained symptoms despite appropriate treatment, but not to make the diagnosis. In patients with overt gastrointestinal bleeding, and negative findings on esophagogastroduodenoscopy and colonoscopy, CE should be performed as soon as possible. CE was recommended only in selected patients with unexplained, mild, chronic iron-deficiency anemia. CE was suggested for surveillance in patients with polyposis syndromes or other small-bowel cancers, who required small-bowel studies. Colon capsule endoscopy should not be substituted routinely for colonoscopy. Patients should be made aware of the potential risks of CE including a failed procedure, capsule retention, or a missed lesion. Finally, standardized criteria for training and reporting in CE should be defined. CONCLUSIONS CE generally should be considered a complementary test in patients with gastrointestinal bleeding, Crohn's disease, or celiac disease, who have had negative or inconclusive endoscopic or imaging studies.
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Affiliation(s)
- Robert A Enns
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Lawrence Hookey
- Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - David Armstrong
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Charles N Bernstein
- Section of Gastroenterology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Steven J Heitman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Teshima
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Grigorios I Leontiadis
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Frances Tse
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Sadowski
- Division of Gastroenterology, Royal Alexandria Hospital, Edmonton, Alberta, Canada
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Hookey L, Louw J, Wiepjes M, Rubinger N, Van Weyenberg S, Day AG, Paterson W. Lack of benefit of active preparation compared with a clear fluid-only diet in small-bowel visualization for video capsule endoscopy: results of a randomized, blinded, controlled trial. Gastrointest Endosc 2017; 85:187-193. [PMID: 27451294 DOI: 10.1016/j.gie.2016.07.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 07/01/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Controversy remains regarding the type and amount of precapsule bowel cleansing required for small-bowel video capsule endoscopy (VCE). This study aims to assess the efficacy and tolerance of 2 active preparations and a control group of clear fluids only. METHODS Patients with clinical indications for VCE were randomized to (1) clear fluids only the evening before VCE, (2) 2 sachets of sodium picosulfate plus magnesium sulfate (P/MC) the evening before, or (3) 2 L of polyethylene glycol (PEG) the evening before. Diet instructions were the same for all 3 groups. Small-bowel cleansing was assessed in 3 ways: a 5-point ordinal scale (primary outcome), the percentage of time the small-bowel view was clear, and a validated computerized assessment of cleansing. RESULTS In total, 198 patients were randomized and 175 patients completed the trial with a mean age of 49.2 years. There was no clear benefit of active preparation with either P/MC or PEG over clear fluids only in the overall 5-point rating scale or in the distal fourth of each examination. There was no difference in diagnostic yield between groups. Significant differences were seen concerning tolerance of the preparations, with a higher proportion rating it as easy or very easy in the clear fluids-only group (93%) and the P/MC group (67%) than in the PEG group (13%) (P < .0001). CONCLUSIONS Small-bowel cleansing for VCE remains a controversial topic. This randomized control trial demonstrates no benefit in overall or distal small-bowel visualization with active preparation using either PEG or P/MC compared with clear fluids only. (Clinical trial registration number: NCT00677794.).
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Affiliation(s)
- Lawrence Hookey
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
| | - Jacob Louw
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
| | - Michelle Wiepjes
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
| | - Natalie Rubinger
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
| | - Stijn Van Weyenberg
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Andrew G Day
- Clinical Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - William Paterson
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
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Black KR, Truss W, Joiner CI, Peter S, Weber FH. A Single-Center Randomized Controlled Trial Evaluating Timing of Preparation for Capsule Enteroscopy. Clin Endosc 2015; 48:234-8. [PMID: 26064824 PMCID: PMC4461668 DOI: 10.5946/ce.2015.48.3.234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 06/29/2014] [Accepted: 09/22/2014] [Indexed: 12/14/2022] Open
Abstract
Background/Aims Intestinal lavage (IL) administration immediately before capsule enteroscopy (CE) is superior to lavage the day before the procedure. We aimed to determine the effect of IL timing on CE diagnostic yield. Methods Patients referred for CE were randomized prospectively into two equal groups according to the timing of IL with 2 L of polyethylene glycol solution. Group A and B underwent IL over 2 hours beginning 14 and 4 hours, respectively, before the scheduled CE. The primary outcome measure was preparation quality, measured with a predetermined validated grading scale. Results A total of 34 patients were randomized. The frequency of mucosal abnormalities (77% vs. 82%, p=not significant [NS]) and diagnostic yield (47% vs. 53%, p=NS) were similar between the two groups. Moreover, no significant association between the quality of small bowel preparation and the timing at which the purgative for IL was administered was observed (overall fluid transparency, p=0.936; overall mucosal invisibility, p=0.091). Conclusions Day-before IL is equivalent to same-day IL in terms of overall preparation quality, proportion of complete studies to cecum, small bowel transit time, frequency of identified mucosal abnormalities, and overall diagnostic yield.
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Affiliation(s)
- Katherine R Black
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wiley Truss
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia I Joiner
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shajan Peter
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Frederick H Weber
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA
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Farnbacher MJ, Keles M, Meier M, Hagel A, Schneider T. Capsule endoscopy in a network cooperation: assessment of the experience in 822 patients. Scand J Gastroenterol 2013; 48:1088-94. [PMID: 23834066 DOI: 10.3109/00365521.2013.812678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Capsule endoscopy (CE) is firmly established as a standard procedure in the diagnostic algorithm of occult or obscure gastrointestinal bleeding and Crohn's disease. Despite its excellent diagnostic yield, missing expertise, reading time and financial expenditure limit an area-wide availability. A multicentric cooperation might compensate these disadvantages. METHODS CE device was bought by a central hospital (CH). Requested equipment is transported to the network partner (NP) and the procedure performed at the spot in personal responsibility. Video reading is exclusively done in the CH. RESULTS Within 10 years, 822 CE (438 m., 384 f.; 63 ± 17 (13-92) years) were performed by 18 cooperating gastroenterological departments. 587/822 (71%) CE were done at NP, 235/822 (29%) in the CH. Between 2002 (n = 39) and 2011 (n = 123) the annual number of CE increased threefold. 95% of the capital investment in each cooperating hospital could be avoided by sharing one workstation within the network. Leading indication for CE was suspected mid-GI-bleeding (80%). Mean latencies between requested date and actual examination were 0 and between equipment's return and report 2 days. 45/191(24%) flexible enteroscopies performed in the CH followed CE findings from NP. DISCUSSION Our 10 years experience show that mobile use of CE is feasible providing quality parameters similar to a single center solution, increases the number of CE investigations, therefore, improves reading expertise and enables both an area-wide and economic offer for this technique. Additionally, patients with the need for invasive enteroscopy are identified and attracted to that NP who provides an invasive SB endocopy device.
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Affiliation(s)
- Michael Julius Farnbacher
- Department of Medicine 2, Teaching Hospital Klinikum Fuerth, Friedrich-Alexander-University Erlangen-Nuremberg, 90766 Fuerth, Germany.
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Belsey J, Crosta C, Epstein O, Fischbach W, Layer P, Parente F, Halphen M. Meta-analysis: efficacy of small bowel preparation for small bowel video capsule endoscopy. Curr Med Res Opin 2012; 28:1883-90. [PMID: 23136911 DOI: 10.1185/03007995.2012.747953] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE It is unclear whether small bowel visibility in video capsule endoscopy (VCE) is enhanced by the use of bowel preparation in addition to pre-procedural fasting. The objective of this study was to clarify this issue by means of a systematic review of the literature and meta-analysis. METHODS Randomised controlled trials comparing the use of laxative bowel preparation with fasting alone were identified using a literature search. Categorical measures of treatment efficacy were extracted from qualifying studies and pooled using random-effects meta-analyses. Primary analysis compared any bowel preparation with fasting alone; subsidiary analyses assessed diagnostic yield and results for each regimen. RESULTS Eight studies were identified, using either polyethylene glycol (PEG) or sodium phosphate (NaP) based regimens. No qualifying studies were identified using other laxatives. Study quality was sufficiently high to warrant meta-analysis. Use of any form of bowel preparation yielded significantly better visibility than fasting alone (OR = 2.31; 95% CI = 1.46-3.63; p < 0.0001). Similar results were seen for diagnostic yield (OR = 1.88; 95% CI = 1.24-2.84; p = 0.023). When sub-analysed according to the treatment used, PEG-based regimens showed benefit (OR = 3.11; 95% CI = 1.96-4.94; p < 0.0001), while NaP-based regimens yielded no significant difference from fasting alone (OR = 1.32; 95% CI = 0.59-2.96; p < 0.0001). LIMITATIONS The study did not consider results from retrospective studies, nor those which did not give a categorical measure of efficacy. The impact of prokinetic and other adjunctive treatments was not considered. The results are only relevant to the most commonly used video capsule, as data for newer alternative devices have not yet been published. CONCLUSION Based on the results of this analysis, the use of bowel preparation alongside fasting is recommended for VCE. PEG-based regimens offer a clear advantage in these patients, while the currently available evidence base does not support the use of NaP. For VCE, lower volume PEG appears to be as efficacious as higher volumes traditionally used for colonoscopy preparation.
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Sakai E, Endo H, Kato S, Matsuura T, Tomeno W, Taniguchi L, Uchiyama T, Hata Y, Yamada E, Ohkubo H, Higrashi T, Hosono K, Takahashi H, Nakajima A. Capsule endoscopy with flexible spectral imaging color enhancement reduces the bile pigment effect and improves the detectability of small bowel lesions. BMC Gastroenterol 2012; 12:83. [PMID: 22748141 PMCID: PMC3444425 DOI: 10.1186/1471-230x-12-83] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 06/19/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Capsule endoscopy with flexible spectral imaging color enhancement (CE-FICE) has been reported to improve the visualization and detection of small-bowel lesions, however, its clinical usefulness is still not established. Therefore, we conducted a study to evaluate whether CE-FICE contributes to improve the detectability of small-bowel lesions by CE trainees. METHODS Four gastroenterology trainees without prior CE experience were asked to read and interpret 12 CE videos. Each of the videos was read by conventional visualization method and under three different FICE settings. To evaluate whether the lesion recognition ability of the CE trainees could be improved by the FICE technology, the lesion detection rate under each of the three FICE settings was compared with that by conventional CE. CE trainees tend to miss small-bowel lesions in bile-pigment-positive condition, therefore we evaluated whether CE-FICE contributes to reducing the bile-pigment effect. The bile-pigment condition was determined by the color values around the small-bowel lesions according to the results of the receiver-operating-characteristic analysis. Moreover, we also evaluated whether poor bowel preparion might affect the accuracy of lesion recognition by CE-FICE. RESULTS Of a total of 60 angioectasias, CE trainees identified 26 by conventional CE, 40 under FICE setting 1, 38 under FICE setting 2, and 31 under FICE setting 3. Of a total of 82 erosions/ulcerations, CE trainees identified 38 by conventional CE, 62 under FICE setting 1, 60 under FICE setting 2, and 20 under FICE setting 3. Compared with conventional CE, FICE settings 1 and 2 significantly improved the detectability of angioectasia (P = 0.0017 and P = 0.014, respectively) and erosions/ulcerations (P = 0.0012 and P = 0.0094, respectively). Although the detectability of small-bowel lesions by conventional CE (P = 0.020) and under FICE setting 2 (P = 0.0023) was reduced by the presence of bile-pigments, that under FICE setting 1 was not affected (P = 0.59). Our results also revealed that in poor bowel visibility conditions, CE-FICE yielded a high rate of false-positive findings. CONCLUSIONS CE-FICE may reduce the bile-pigment effect and improve the detectability of small-bowel lesions by CE trainees; the reliability of CE-FICE may be improved by good bowel preparation.
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Affiliation(s)
- Eiji Sakai
- Gastroenterology Division, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hiroki Endo
- Gastroenterology Division, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shingo Kato
- Gastroenterology Division, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tetsuya Matsuura
- Gastroenterology Division, Chigasaki City Hospital, Chigasaki, Japan
| | - Wataru Tomeno
- Gastroenterology Division, Chigasaki City Hospital, Chigasaki, Japan
| | - Leo Taniguchi
- Gastroenterology Division, Chigasaki City Hospital, Chigasaki, Japan
| | - Takashi Uchiyama
- Gastroenterology Division, Chigasaki City Hospital, Chigasaki, Japan
| | - Yasuo Hata
- Gastroenterology Division, Chigasaki City Hospital, Chigasaki, Japan
| | - Eiji Yamada
- Gastroenterology Division, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hidenori Ohkubo
- Gastroenterology Division, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takuma Higrashi
- Gastroenterology Division, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Kunihiro Hosono
- Gastroenterology Division, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hirokazu Takahashi
- Gastroenterology Division, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Atsushi Nakajima
- Gastroenterology Division, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Ito T, Ohata K, Ono A, Chiba H, Tsuji Y, Sato H, Matsuhashi N. Prospective controlled study on the effects of polyethylene glycol in capsule endoscopy. World J Gastroenterol 2012; 18:1789-1792. [PMID: 22553403 PMCID: PMC3332292 DOI: 10.3748/wjg.v18.i15.1789] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 09/14/2011] [Accepted: 02/26/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To prospectively confirm whether a small amount of polyethylene glycol (PEG) ingested after swallowing endoscopy capsule improves image quality and completion rate. METHODS Forty-four consecutive patients referred to us for capsule endoscopy (CE) were randomized to two groups. All patients were restricted to clear fluids for 12 h before the examination. Patients in group A (22 cases) received no additional preparation, while those in group B (20 cases) ingested 500 mL of PEG within a 2 h period starting 30 min after swallowing the capsule. Clear fluids and meals were allowed 2 h and 4 h after capsule ingestion, respectively. Image quality was assessed as the percentage of visualized bowel surface area as follows: 1: < 25%; 2: 25%-49%; 3: 50%-74%; 4: 75%-89%; 5: > 90%. The small bowel record was divided into five segments by time, and the score for each segment was evaluated. All CE examinations were performed with the Pillcam SB capsule endoscopy system (Given Imaging Co. Ltd., Yoqnem). RESULTS This study ended in December 2009, because sample size was considered large enough. A total of 44 patients were enrolled. Two patients in group B were excluded from the analysis because small bowel images could not be obtained from these patients; one had a full stomach, while the other presented with a massive gastric bleed. Thus, 22 patients from group A and 20 patients from group B completed the study. There was no significant difference in age (P = 0.22), sex (P = 0.31), and indication for CE. No significant adverse events occurred in any of the study patients. In group A, image quality deteriorated as the capsule progressed distally. However, in group B, image quality was maintained to the distal small bowel. In each of the five segments, the visibility score was significantly higher in group B than in group A (segment 1: 4.3 ± 0.7 vs 4.7 ± 0.5, P = 0.03; segment 2: 4.2 ± 0.9 vs 4.8 ± 0.4, P = 0.01; segment 3: 4.0 ± 1.0 vs 4.6 ± 0.7, P = 0.04; segment 4: 3.6 ± 1.1 vs 4.5 ± 0.6, P = 0.003; segment 5: 2.7 ± 1.0 vs 4.4 ± 0.8, P = 0.00004). Thus, the use of PEG during CE examination significantly improved image quality in all time segments, and this effect was more pronounced in the distal ileum. The completion rate to the cecum was not significantly different between groups A and B (81.8% vs 85.0%, P = 0.89). There was no difference in the gastric transit time between groups (36.2 ± 35.0 min vs 54.0 ± 56.6 min, P = 0.23), but the small bowel transit time was significantly longer in group A than in group B (246.0 ± 107.0 min vs 171.0 ± 104.0 min, P = 0.04). CONCLUSION The ingestion of a small amount of PEG after the swallowing of an endoscopy capsule significantly improved CE image quality, but did not enhance the completion rate to the cecum.
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Pons Beltrán V, González Suárez B, González Asanza C, Pérez-Cuadrado E, Fernández Diez S, Fernández-Urién I, Mata Bilbao A, Espinós Pérez JC, Pérez Grueso MJ, Argüello Viudez L, Valle Muñoz J, Carballo Alvarez F, Muñoz-Navas M, Llach Vila J, Ramírez Armengol JA, Balanzó Tintoré J, Sala Felis T, Menchen Fernández-Pacheco P. Evaluation of different bowel preparations for small bowel capsule endoscopy: a prospective, randomized, controlled study. Dig Dis Sci 2011; 56:2900-5. [PMID: 21479818 DOI: 10.1007/s10620-011-1693-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 03/25/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS To obtain an adequate view of the whole small intestine during capsule endoscopy (CE) a clear liquid diet and overnight fasting is recommended. However, intestinal content can hamper vision in spite of these measures. Our aim was to evaluate tolerance and degree of intestinal cleanliness during CE following three types of bowel preparation. PATIENTS AND METHODS This was a prospective, multicenter, randomized, controlled study. Two-hundred ninety-one patients underwent one of the following preparations: 4 L of clear liquids (CL) (group A; 92 patients); 90 mL of aqueous sodium phosphate (group B; 89 patients); or 4 L of a polyethylene glycol electrolyte solution (group C; 92 patients). The degree of cleanliness of the small bowel was classified by blinded examiners according to four categories (excellent, good, fair or poor). The degree of patient satisfaction, gastric and small bowel transit times, and diagnostic yield were measured. RESULTS The degree of cleanliness did not differ significantly between the groups (P = 0.496). Interobserver concordance was fair (k = 0.38). No significant differences were detected between the diagnostic yields of the CE (P = 0.601). Gastric transit time was 35.7 ± 3.7 min (group A), 46.1 ± 8.6 min (group B) and 34.6 ± 5.0 min (group C) (P = 0.417). Small-intestinal transit time was 276.9 ± 10.7 min (group A), 249.7 ± 13.1 min (group B) and 245.6 ± 11.6 min (group C) (P = 0.120). CL was the best tolerated preparation. Compliance with the bowel preparation regimen was lowest in group C (P = 0.008). CONCLUSIONS A clear liquid diet and overnight fasting is sufficient to achieve an adequate level of cleanliness and is better tolerated by patients than other forms of preparation.
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Affiliation(s)
- Vicente Pons Beltrán
- Gastroenterology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.
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Park SC, Keum B, Seo YS, Kim YS, Jeen YT, Chun HJ, Um SH, Kim CD, Ryu HS. Effect of bowel preparation with polyethylene glycol on quality of capsule endoscopy. Dig Dis Sci 2011; 56:1769-75. [PMID: 21161380 DOI: 10.1007/s10620-010-1500-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 11/15/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Capsule endoscopy (CE) has the problem that lumen visualization is impaired by bubbles, bile, and debris. The benefits of bowel preparation are still controversial and the best method remains to be determined. The objective of this study was to evaluate the effect of the method of bowel preparation on the quality of visualization and on transit time. METHODS The study sample consisted of 68 patients for CE. Patients were randomly allocated to three groups. In group A (n = 23), patients fasted for 12 h before CE. In groups B (n = 20) and C (n = 25), patients received 2 and 4 l of polyethylene glycol (PEG), respectively. Small bowel images were evaluated by use of a cleansing score system. Representative frames were serially selected at 5-min intervals and scored by assessment of two properties (proportion of luminal visibility and extent of obscuration). RESULTS The median scores of image quality in groups A, B, and C were 2.26, 2.43, and 2.55 respectively, (P = 0.034). Cecal completion rates, gastric transit time, and small bowel transit time were no different among the three groups. Detection of lesions in groups A, B, and C was 56.5, 65.0, and 68.0%, respectively. CONCLUSIONS Bowel preparation with PEG resulted in better image quality than fasting alone. No significant difference was observed between 2 and 4 l. PEG 2 l rather than 4 l may be a useful method of preparation for CE.
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Affiliation(s)
- Sung Chul Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Korea
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Triantafyllou K. Can we improve the diagnostic yield of small bowel video-capsule endoscopy? World J Gastrointest Endosc 2010; 2:143-6. [PMID: 21160741 PMCID: PMC2999125 DOI: 10.4253/wjge.v2.i5.143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 03/15/2010] [Accepted: 03/22/2010] [Indexed: 02/05/2023] Open
Abstract
Video-capsule endoscopy has revolutionized the examination of small bowel mucosa. However, this modality is relatively young and its diagnostic yield is low. Herein, we discuss different approaches to improve examination’s diagnostic yield. There are strong data supporting some of them while there is speculation about the rest. As capsule endoscopy continues to evolve there is also a strong belief that technology will overcome at least some of the obstacles that hamper capsule endoscopy’s diagnostic yield sometime in the near future.
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Affiliation(s)
- Konstantinos Triantafyllou
- Konstantinos Triantafyllou, Hepatogastroenterology Unit, 2nd Department of Internal Medicine - Propaedeutic, Medical School, Athens University, "Attikon" University General Hospital, Haidari 12464, Greece
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Liao Z, Gao R, Xu C, Li ZS. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 2010; 71:280-6. [PMID: 20152309 DOI: 10.1016/j.gie.2009.09.031] [Citation(s) in RCA: 439] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Accepted: 09/25/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Capsule endoscopy (CE) has been widely used in clinical practice. OBJECTIVE To provide systematically pooled results on the indications and detection, completion, and retention rates of small-bowel CE. DESIGN A systematic review. MAIN OUTCOME MEASUREMENTS We searched the PubMed database (2000-2008) for original articles relevant to small-bowel CE for the evaluation of patients with small-bowel signs and symptoms. Data on the total number of capsule procedures, the distribution of different indications for the procedures, the percentages of procedures with positive detection (detection rate), complete examination (completion rate), or capsule retention (retention rate) were extracted and/or calculated, respectively. In addition, the detection, completion, and retention rates were also extracted and/or calculated in relation to indications such as obscure GI bleeding (OGIB), definite or suspected Crohn's disease (CD), and neoplastic lesions. RESULTS A total of 227 English-language original articles involving 22,840 procedures were included. OGIB was the most common indication (66.0%), followed by the indication of only clinical symptoms reported (10.6%), and definite or suspected CD (10.4%). The pooled detection rates were 59.4%; 60.5%, 55.3%, and 55.9%, respectively, for overall, OGIB, CD, and neoplastic lesions. Angiodysplasia was the most common reason (50.0%) for OGIB. The pooled completion rate was 83.5%, with the rates being 83.6%, 85.4%, and 84.2%, respectively, for the 3 indications. The pooled retention rates were 1.4%, 1.2%, 2.6%, and 2.1%, respectively, for overall and the 3 indications. LIMITATIONS Inclusion and exclusion criteria were loosely defined. CONCLUSIONS The pooled detection, completion, and retention rates are acceptable for total procedures. OGIB is the most common indication for small-bowel CE, with a high detection rate and low retention rate. In addition, angiodysplasia is the most common finding in patients with OGIB. A relatively high retention rate is associated with definite or suspected CD and neoplasms.
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Affiliation(s)
- Zhuan Liao
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2009; 16:260-77. [PMID: 19390324 DOI: 10.1097/med.0b013e32832c937e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Xu L, Lv NH, Zhu X, Xu P, Chen YX, Zhu Y, He HC, Hua KL. Bowel preparation for capsule endoscopy in organ dysfunction patients. Shijie Huaren Xiaohua Zazhi 2008; 16:3242-3245. [DOI: 10.11569/wcjd.v16.i28.3242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the bowel preparation for capsule endoscopy (CE) in patients with organ dysfunction.
METHODS: Forty three patients suspected of bowel diseases in our hospital were included in this prospective study. Control group (Group A, without organ dysfunction or failure) were treated with sodium phosphate and enough water. Twenty three organ dysfunction patients were randomly assigned to group B (liquid diet for 3 d, less sodium phosphate and less water) and to group C (fasting 3 d and parenteral alimentation). Indicators including the comfort, enteric visibility and extensity of patients were observed.
RESULTS: Group B and group C, which showed no significant difference between themselves, had better comfort than group A during the examination. There was not significant difference in cleanness and visibility on CE in whole small bowel between group A and group B. Group C showed decreased visibility in lower-half small bowel, but no difference in upper-half small bowel, compared with group A and B (12.6 ± 3.6 vs 52.4 ± 13.3, 46.6 ± 8.1; 21.2 ± 9.3 vs 46.4 ± 11.2, 49.7 ± 9.3, all P < 0.01). Extensity of group C was less than group A and group B (24.4 ± 4.8 vs 45.2 ± 8.2, 46.5 ± 9.4, both P < 0.01).
CONCLUSION: Capsule endoscopy can be performed on organ dysfunction patients. According to location of diseases, appropriate bowel preparation is needed, for example, some laxative and less water for whole small bowel, and 3 d fasting for upper-half small bowel.
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