Preparation Regimens to Improve Capsule Endoscopy Visualization and Diagnostic Yield (PrepRICE): a multicenter...

Area of Science:

• Gastroenterology
• Endoscopy
• Diagnostic Imaging

Background:

• Current guidelines recommend bowel preparation before small-bowel capsule endoscopy (SBCE).
• The optimal timing and protocol for bowel preparation remain undefined.
• This study addresses the need for evidence-based preparation protocols in SBCE.

Purpose of the Study:

• To compare the efficacy of four different purgative regimens for SBCE.
• To evaluate the impact of preparation timing on small-bowel visualization quality (SBVQ) and diagnostic yield (DY).
• To assess patient-reported outcomes and tolerability of different SBCE preparation protocols.

Main Methods:

• A prospective, randomized, multicenter study involving 387 patients with suspected small-bowel bleeding.
• Four purgative regimens were compared: night before (G1), morning of (G2), split dose (G3), and intraprocedure (G4).
• SBVQ (Brotz score), DY, transit times, and patient tolerability were assessed for each regimen.

Main Results:

• Intraprocedure purgative regimens (G3 and G4) significantly improved SBVQ and DY compared to G1 and G2.
• Patients receiving intraprocedure purgatives showed shorter small-bowel transit times and higher angioectasia detection rates.
• The G4 regimen, administered entirely after capsule ingestion, demonstrated superior patient satisfaction and tolerability.

Conclusions:

• Bowel preparation administered during the procedure (intraprocedure) enhances visualization and diagnostic yield in SBCE.
• Traditional night-before preparation is associated with poorer outcomes.
• The G4 regimen is recommended for its effectiveness and optimal patient tolerability.