Capsule endoscopy is a well accepted tool for evaluation of small bowel pathologies (e.g., bleeding sources). However, it has some limitations due to restricted recording time and reduced visibility by air and residual material. Several forms of preparation (e.g., prokinetic drugs, laxatives and defoaming agents) have been tried to improve the quality of the examination. However, to date no standardized protocol has been recommended for bowel preparation for CE.
This study, described in a research article, is to be published on April 7, 2008 in the World Journal of Gastroenterology.
We examined the effect of a combination of a saline (sodium phosphate) and a stimulant laxative (bisacodyl, Prepacol(R), Guerbet GmbH, Sulzbach, Germany) as a preparation before CE. Sodium phosphate solution is poorly absorbable and impedes water absorption from the gut through the osmotic gradient. Bisacodyl changes the net absorption of sodium and water in the small bowel into a net secretion and accelerates small intestinal transit.
52 consecutive patients receiving capsule endoscopy were included. The patients were prospectively randomized into two groups. Group A fasted at least 8 h before the examination; group B received additional Prepacol(R). Capsule endoscopy films were evaluated by three independent, endoscopically experienced investigators who were blinded concerning the kind of preparation. The following parameters were assessed: total quality of the film, visibility of small bowel mucosa, velocity of the capsule and occurrence of foam, air and residual food. Every parameter was graded from 1 to 4, as excellent, good, limited and poor quality.
Preparation with Prepacol(R) accelerated small bowel transit time , but had no effect on the different parameters of CE quality.
In the view of the authors, the investigated combination of sodium phosphate and bisacodyl is an inappropriate preparation for CE. Because CE is an expensive and time consuming examination, an effective preparation is essential to minimize false results at the best possible rate. Further studies considering the patient's compliance, which might be reduced by the taste of the preparation, are necessary to identify sufficient preparation procedures.
Reference: Franke A, Hummel F, Knebel P, Antoni C, Böcker U, Singer MV, Löhr M. Prospective evaluation of small bowel preparation with bisacodyl and sodium phosphate for capsule endoscopy. World J Gastroenterol 2008; 14(13): 2061-2064 http://www.wjgnet.com/1007-9327/14/2061.asp
Correspondence to: Andreas Franke, MD, Department of Medicine II (Gastroenterology, Hepatology and Infectious Diseases), University Hospital of Heidelberg at Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim D-68167, Germany. a.franke@gmx.net Telephone: +49-621-383-3359 Fax: +49-621-383-3805
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World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection It provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th of every month. The WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the title China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
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