Clinical utility of purgative bowel preparation before capsule endoscopy: a multicenter, blinded, randomized controlled trial

医学 耐受性 随机对照试验 胶囊内镜 置信区间 内科学 养生 胃肠病学 内窥镜检查 结肠镜检查 临床试验 外科 不利影响 结直肠癌 癌症
作者
Mehul Lamba,Kimberley Ryan,Jason Hwang,Florian Grimpen,Gary Lim,Dale Cornelius,Alan Moss,Eu Jin Lim,Gregor J. Brown,Nam Q. Nguyen,Marcus Tippett,Andrew C.F. Taylor,Mark Appleyard
出处
期刊:Gastrointestinal Endoscopy [Elsevier BV]
卷期号:96 (5): 822-828.e1 被引量:10
标识
DOI:10.1016/j.gie.2022.07.010
摘要

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.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).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).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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