Preparations and prokinetics

The evaluation of the importance of bowel preparations, prokinetics and postural tricks for bowel cleanliness, completeness of evaluation, and ultimately for the diagnostic yield of VCE is hampered by several factors. First, most studies are published in abstract form. Second, the methodological quality of the studies is rather low, because randomized comparisons are only a small minority. Third,there is no accepted and validated scale to evaluate bowel cleanliness. For all of these reasons, comparisons between studies are very difficult, and drawing general conclusions is almost impossible. As a consequence, at the Fifth International Conference on Capsule Endoscopy [9], only a limited measure of consensus could be reached on the fact that preparations/prokinetics probably improve the quality of small bowel cleanliness. It also was agreed that it is possible that preps/prokinetics improve GTT, SBTT and completeness of examination, and that keeping the patients recumbent in the right lateral position may shorten the GTT. It was noted, however, that the best type of preparation, and dose and time of administration remain to be determined. Additionally, data on prokinetics and postural tricks are insufficient to reach a firm conclusion. Unanswered questions concern the effect of medications on the diagnostic yield of VCE, whether prokinetics increase the miss rate, whether preparations/prokinetics cause adverse effects and the influence of medications on patient acceptance.