Video capsule endoscopy: is bowel preparation necessary?

• Published in: Journal of investigative medicine 2016-08, Vol.64 (6), p.1114-1117
• Main Authors: Catalano, Carmine, Companioni, Rafael Antonio Ching, Khankhanian, Pouya, Vyas, Neil, Patel, Ishan, Bansal, Raghav, Walfish, Aaron
• Format: Article
• Language: English
• Subjects: Capsule Endoscopy; Diabetes; Electronic health records; Endoscopy; Fasting; Female; Gastroenterology; Humans; Intestine, Small - physiopathology; Male; Medical records; Middle Aged; Polyethylene glycol; Studies
• ISSN: 1081-5589; 1708-8267
• DOI: 10.1136/jim-2016-000153

There is no standardized protocol for bowel preparation prior to video capsule endoscopy, although one is strongly recommended. The purpose of our study was to see if there was a statistical significance between small bowel mucosal visualization rates for those who received bowel preparation and those who did not. We retrospectively analyzed all patients who had a video capsule endoscopy from August 2014 to January 2016 at a tertiary care center. All patients fasted prior to the procedure. Bowel preparation when used consisted of polyethylene glycol. A long fast consisted of 12 or more hours. The grading system used to assess the small bowel was adapted from a previously validated system from Esaki et al. Statistical analyses were performed using Fisher's exact test or Welch's 2-sample t-test and statistical significance was present if the p value was ≤0.05. 76 patients were carried forward for analysis. Small bowel mucosal visualization rates were similar between those who received bowel preparation and those who did not (92.5% vs 88.9%, p=0.44). Small bowel mucosal visualization rates were significantly better in those patients who had a long fast compared with those who had a short fast (97.7% vs 81.3%, p=0.019). Our study demonstrates that the addition of bowel preparation prior to video capsule endoscopy does not significantly improve small bowel mucosal visualization rates and, in addition, there is a statistically significant relationship between increased fasting time and improved small bowel mucosal visualization. A prolonged fast without bowel preparation might be satisfactory for an adequate small bowel visualization but further randomized, prospective studies are necessary to confirm these findings.