Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 5, 2021; 12(6): 103-112
Published online Nov 5, 2021. doi: 10.4292/wjgpt.v12.i6.103
Addition of castor oil as a booster in colon capsule regimens significantly improves completion rates and polyp detection
Serhiy Semenov, Mohd Syafiq Ismail, Fintan O'Hara, Sandeep Sihag, Barbara Ryan, Anthony O'Connor, Sarah O'Donnell, Deirdre McNamara
Serhiy Semenov, Mohd Syafiq Ismail, Fintan O'Hara, Sandeep Sihag, Barbara Ryan, Anthony O'Connor, Sarah O'Donnell, Deirdre McNamara, Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland
Serhiy Semenov, Mohd Syafiq Ismail, Fintan O'Hara, Sandeep Sihag, Deirdre McNamara, Trinity Academic Gastroenterology Group, Trinity College Dublin, Dublin D 2, Ireland
Author contributions: Semenov S is the primary author of this study and is responsible for writing, editing and submitting the manuscript; Semenov S and McNamara D designed the research study; Semenov S, Ismail MS, Sihag S and O'Hara F assisted in data collection; O'Connor A, O'Donnell S, Ryan B and McNamara D played vital advisory roles in facilitating ethical approval, editing the manuscript and data collection.
Institutional review board statement: This study was approved and registered on the November 15, 2019, as a service evaluation project by the process improvement department which is part of the quality safety and risk management directorate of Tallaght University Hospital, Tallaght, Dublin 24, Ireland.
Informed consent statement: This form is not applicable as this study has been registered as a service evaluation project by the process improvement department which is part of the quality safety and risk management directorate in our hospital.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: Consent for data sharing was not obtained as the presented data is anonymized as per registration agreement with the quality safety and risk management directorate of our hospital.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Serhiy Semenov, MRCP, Doctor, Gastroenterology Department, Tallaght University Hospital, Tallaght Dublin 24, Dublin D 24, Ireland. semenovs@tcd.ie
Received: March 1, 2021
Peer-review started: March 1, 2021
First decision: April 18, 2021
Revised: May 2, 2021
Accepted: September 3, 2021
Article in press: September 3, 2021
Published online: November 5, 2021
Abstract
BACKGROUND

Incomplete excretion rates are problematic for colon capsule endoscopy (CCE). Widely available booster regimens are suboptimal. Recently published data on one day preparation CCE protocol using castor oil appeared effective.

AIM

To assess the impact of adding castor oil to a standard split-dose (2-d) preparation in an unselected Western patient cohort.

METHODS

All patients aged 18 or more referred to our unit for a CCE over a 5-mo period were prospectively recruited. Controls were retrospectively identified from our CCE database. All patients received split bowel preparation with Moviprep® [polyethylene glycol (PEG)-3350, sodium sulphate, sodium chloride, potassium chloride, sodium ascorbate and ascorbic acid for oral solution; Norgine B. V, United States], a PEG-based solution used predominantly in our colonoscopy practice. Control booster regimen included Moviprep® with 750 mL of water (booster 1) on reaching the small bowel. A further dose of Moviprep® with 250 mL of water was given 3 h later and a bisacodyl suppository (Dulcolax®) 10 mg after 8 h, if the capsule was not excreted. In addition to our standard booster regimen, cases received an additional 15 mL of castor oil given at the time of booster 1. A nested case control design with 2:1 ratio (control:case) was employed. Basic demographics, completion rates, image quality, colonic transit time, diagnostic yield and polyp detection were compared between groups, using a student t or chi-square tests as appropriate.

RESULTS

One hundred and eighty-six CCEs [mean age 60 years (18-97), 56% females, n = 104], including 62 cases have been analysed. Indication breakdown included 96 polyp surveillance (51.6%), 42 lower gastrointestinal symptoms (22.6%), 28 due to incomplete colonoscopy (15%), 18 anaemia (9.7%) and 2 inflammatory bowel disease surveillance (1.1%). Overall, CCE completion was 77% (144/186), image quality was adequate/diagnostic in 91% (170/186), mean colonic transit time was 3.5 h (0.25-13), and the polyp detection rate was 57% (106/186). Completion rates were significantly higher with castor oil, 87% cases (54/62) vs 73% controls (90/124), P = 0.01. The number needed to treat with castor oil to result in an additional complete CCE study was 7, absolute risk reduction = 14.52%, 95% confidence interval (CI): 3.06- 25.97. This effect of castor oil on excretion rates was more significant in the over 60 s, P < 0.03, and in females, P < 0.025. Similarly, polyp detection rates were higher in cases 82% (51/62) vs controls 44% (55/124), P = 0.0001, odds ratio 5.8, 95%CI: 2.77-12.21. Colonic transit times were similar, 3.2 h and 3.8 h, respectively. Image quality was similar, reported as adequate/ diagnostic in 90% (56/62) vs 92% (114/124).

CONCLUSION

In our capsule endoscopy centre, castor oil addition as a CCE booster significantly improved completion rates and polyp detection in an unselected Western cohort.

Keywords: Castor oil, Colon capsule endoscopy, Bowel preparation, Completion rates, Excretion rates

Core Tip: This is the largest prospective study to date, assessing the impact of castor oil and its novel use as a colon capsule endoscopy (CCE) booster in an unselected cohort. Our study shows that adding castor oil to a simple split-dose CCE bowel preparation regime has a significant impact on capsule excretion rates and polyp detection.