Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 10, 2016; 8(11): 433-438
Published online Jun 10, 2016. doi: 10.4253/wjge.v8.i11.433
Low volume polyethylene glycol with ascorbic acid, sodium picosulfate-magnesium citrate, and clear liquid diet alone prior to small bowel capsule endoscopy
Erin Rayner-Hartley, Majid Alsahafi, Paula Cramer, Nazira Chatur, Fergal Donnellan
Erin Rayner-Hartley, Majid Alsahafi, Paula Cramer, Nazira Chatur, Fergal Donnellan, Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia V6Z3H8, Canada
Majid Alsahafi, Department of Medicine, King Abdulaziz University, Jeddah 21342, Saudi Arabia
Author contributions: Chatur N and Donnellan F contributed to study concepts, design and interpretation; Donnellan F contributed to study analysis, editing the manuscript and final approval; Rayner-Hartley E and Cramer P contributed to data acquisition and analysis; Rayner-Hartley E and Alsahafi M contributed to interpretation of results and writing the manuscript.
Institutional review board statement: This was a retrospective study, and institution review board was not required.
Informed consent statement: Consent was not obtained but the presented data are anonymized and risk of identification is low.
Conflict-of-interest statement: No conflict of interest for all authors.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fergal Donnellan, MD, Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, 5153 - 2775 Laurel Street, Vancouver, British Columbia V6Z3H8, Canada. fergal.donnellan@vch.ca
Telephone: +1-604-8755244 Fax: +1-604-8755161
Received: November 5, 2015
Peer-review started: November 7, 2015
First decision: December 10, 2015
Revised: February 10, 2016
Accepted: February 23, 2016
Article in press: February 24, 2016
Published online: June 10, 2016
Abstract

AIM: To compare low volume polyethylene glycol with ascorbic acid, sodium picosulfate-magnesium citrate and clear liquid diet alone as bowel preparation prior to small bowel capsule endoscopy (CE).

METHODS: We retrospectively collected all CE studies done from December 2011 to July 2013 at a single institution. CE studies were reviewed only if low volume polyethylene glycol with ascorbic acid, sodium picosulfate-magnesium citrate or clear liquid diet alone used as the bowel preparation. The studies were then reviewed by the CE readers who were blinded to the preparation type. Cleanliness and bubble burden were graded independently within the proximal, middle and distal small bowel using a four-point scale according to the percentage of small bowel mucosa free of debris/bubbles: grade 1 = over 90%, grade 2 = between 90%-75%, grade 3 = between 50%-75%, grade 4 = less than 50%. Data are expressed as mean ± SEM. ANOVA and Fishers exact test were used where appropriate. P values < 0.05 were considered statistically significant.

RESULTS: A of total of 123 CE studies were reviewed. Twenty-six studies were excluded from analysis because of incomplete small bowel examination. In the remaining studies, 39 patients took low volume polyethylene glycol with ascorbic acid, 31 took sodium picosulfate-magnesium citrate and 27 took a clear liquid diet alone after lunch on the day before CE, followed by overnight fasting in all groups. There was no significant difference in small bowel cleanliness (1.98 ± 0.09 vs 1.84 ± 0.08 vs 1.76 ± 0.08) or small bowel transit time (213 ± 13 vs 248 ± 14 ± 225 ± 19 min) for clear liquid diet alone, MoviPrep and Pico-Salax respectively. The bubble burden in the mid small bowel was significantly higher in the MoviPrep group (1.6 ± 0.1 vs 1.9 ± 0.1 vs 1.6 ± 0.1, P < 0.05). However this did not result in a significant difference in diagnosis of pathology.

CONCLUSION: There was no significant difference in small bowel cleanliness or diagnostic yield of small bowel CE between the three preparations regimens used in this study.

Keywords: Capsule endoscopy, Small bowel, Bowel preparation, Polyethylene glycol, Sodium picosulfate

Core tip: Adequate small bowel preparation is essential for diagnosing small bowel pathology on video capsule endoscopy, but the optimal small bowel preparation method remains unclear. Due the small volume and safety, low volume polyethylene glycol (PEG) based regimens become attractive. However no previous studies have compared low volume PEG with ascorbic acid to sodium picosulfate-magnesium citrate or clear liquid diet alone. In this retrospective study we performed a direct comparison between these three regimens. The bubble burden was significantly higher in the low PEG group but no differences in small bowel cleanliness or diagnostic yield were found between the three regimens.