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Low-dose and same day use of polyethylene glycol improves image of video capsule endoscopy: A multi-center randomized
Shan Wu1,2, Liang Zhong3, Ping Zheng4
1Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.
Insights
Optimal small bowel preparation for video capsule endoscopy (VCE) involves 1-liter polyethylene glycol (PEG) administered 4 hours prior. This method significantly improves visualization and patient acceptance for VCE procedures.
Area of Science:
- Gastroenterology
- Medical Imaging
- Clinical Trials
Background:
- Satisfactory visualization of the small bowel is crucial for accurate video capsule endoscopy (VCE).
- Previous studies have not definitively established the optimal polyethylene glycol (PEG) regimen for VCE preparation.
- Patient tolerance and diagnostic yield are key considerations in VCE preparation.
Purpose of the Study:
- To determine the optimal dose and timing of polyethylene glycol (PEG) for small bowel preparation before VCE.
- To compare the efficacy of different PEG regimens on small bowel visualization quality (SBVQ).
- To assess patient acceptability and diagnostic rates associated with various PEG preparations.
Main Methods:
- A prospective randomized trial involving 410 patients undergoing VCE.
- Patients were assigned to five groups receiving varying doses (1-L or 2-L) and timings (12 hours or 4 hours before VCE) of PEG, or no PEG.
- Primary endpoint was SBVQ; secondary endpoints included patient acceptability and VCE diagnostic rate.
Main Results:
- The group receiving 1-L PEG 4 hours before VCE (Group D) demonstrated significantly higher excellent SBVQ (66.3%) compared to the no-PEG group (32.5%).
- The 4-hour, 1-L PEG regimen also resulted in a higher diagnostic rate in the distal small bowel.
- Patient acceptance was significantly better with 1-L PEG compared to 2-L PEG.
Conclusions:
- Administering 1-L of PEG 4 hours before VCE is the optimal preparation strategy.
- This regimen enhances small bowel visualization and improves patient acceptance for VCE.
- The findings provide evidence-based guidelines for optimizing VCE preparation.
Background And Aim:
Clear visualization of the small bowel is a requirement for satisfactory video capsule endoscopy (VCE). The aim of this study was to identify the optimal dose and timing of polyethylene glycol (PEG) for small bowel preparation before VCE.
Methods:
A total of 410 patients were enrolled in this prospective randomized trial. All patients fasted for 12 h and ingested 320 mg simethicone 30 min before swallowing the capsule. Patients were randomized into five groups: Group A (no PEG), Group B (1-L PEG, 12 h before VCE), Group C (2-L PEG, 12 h before VCE), Group D (1-L PEG, 4 h before VCE), and Group E (2-L PEG, 4 h before VCE). The primary endpoint was small bowel visualization quality (SBVQ), and the secondary endpoints were patient acceptability and diagnosis rate of VCE.
Results:
Excellent SBVQ was achieved in 27 (32.5%) of Group A, 38 (46.3%) of Group B, 40 (48.2%) of Group C, 55 (66.3%) of Group D, and 43 (54.4%) of Group E. The percentage of excellent SBVQ in Group D was significantly more than in Group A (66.3% vs 32.5%, P < 0.001), and diagnostic rate in the distal segment was higher (28.9% vs 10.8%, P = 0.0035). Patient acceptance of 1-L PEG was better than of 2-L PEG (P < 0.005).
Conclusion:
Small bowel cleansing with 1-L PEG given 4 h before VCE was the optimal preparation for visualization of the bowel and patient acceptance (ClinicalTrials.gov, ID: NCT02486536).
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