Optimal approach for small bowel capsule endoscopy using polyethylene glycol and metoclopramide with the assistance...

Capsule endoscopy is limited by the poor image quality of the distal bowel and incomplete small bowel transit. The aim of this study was to establish an optimal medication protocol for capsule endoscopy performed using a real-time viewer.

A total of 80 patients were prospectively recruited. The patients were randomized into two groups: the 'conventional group' (without any preparation) and the 'real-time group' (in which a real-time viewer was attached). At 60 min after swallowing the capsule, if the capsule had reached the small bowel, 500 ml of polyethylene glycol was administered; if the capsule was still located in the stomach, 10 mg of metoclopramide was given intramuscularly, followed by 500 ml of polyethylene glycol solution.

The completion rate was significantly higher in the real-time group as compared with that in the conventional group (72.5 vs. 90.0%). Our protocol yielded a significantly improved image quality of the distal small bowel [image quality score = 1.6 vs. 3.0 (max 4.0)]. The detection rate of lesions in the distal small bowel was higher in the real-time group than in the conventional group.

The present study clearly showed that our protocol yielded an improved completion rate and also improved image quality.