Efficacy of 1 L PEG Ascorbate vs Sodium Picosulfate With Magnesium Citrate Bowel Preparations for Capsule Colonoscopy...

Capsule colonoscopy (CC) and pan-intestinal capsule endoscopy ("panendoscopy") require effective bowel cleansing; however, evidence on ultra-low-volume regimens is lacking. This study compared the efficacy of 1 L polyethylene glycol with ascorbic acid (PEG-Asc) vs sodium picosulfate with magnesium citrate (SPMC) in CC and panendoscopy procedures.

In this prospective, single-center, researcher-blinded, randomized trial, 220 consecutive adult outpatients referred for CC or panendoscopy were assigned 1:1 to receive split-dose PEG-Asc or SPMC. Primary outcomes were adequate bowel cleansing and procedure completion, while secondary outcomes included tolerability and clinically relevant endoscopic findings.

Adequate bowel cleansing was achieved in 70.0% of the PEG-Asc group vs 47.1% of the SPMC group ( P = 0.001). PEG-Asc achieved higher rates of excellent segmental cleansing in the right (32.6% vs 9.4%; P < 0.001) and transverse colon (38.8% vs 15.6%; P < 0.001). Overall completion rates were similar between regimens (PEG-Asc 68.9% vs SPMC 66.7%; P = 0.742), but with CC procedures achieving 62.7% and panendoscopy 87.2% ( P = 0.004). Tolerability was higher with SPMC, reflected by fewer reports of nausea (27.6% vs 42.2%; P = 0.035) and vomiting (9.2% vs 24.4%; P = 0.005), and a greater proportion of patients rating the preparation as "easy" (34.7% vs 21.1%; P = 0.039). Clinically relevant findings, including polyps ≥6 mm, were similar across both groups.

PEG-Asc provides superior bowel cleansing for CC and panendoscopy, whereas SPMC is better tolerated. These findings support PEG-Asc as the first-line ultra-low-volume bowel preparation for capsule-based procedures.