Are bowel purgatives and prokinetics useful for small-bowel capsule endoscopy? A prospective randomized controlled study

Background: Capsule endoscopy (CE) is limited by incomplete small-bowel transit and poor view quality ill the distal bowel. Currently, there is no consensus regarding the use of bowel purgatives or prokinetics in CE. Objective: To evaluate the usefulness Of bowel purgatives and prokinetics in small-bowel CE. Design: Prospective single-blind randomized controlled study Setting: Academic endoscopy unit. Patients: A total of 150 patients prospectively recruited. Intervention: Patients were randomized to 1 of 4 preparations: "standard" (fluid restriction then nothing by mouth 12 hours before the procedure, water and simethicone at capsule ingestion [S]); "standard" + 10 mg Oral metodopramide before the procedure (M); Citramag + senna bowel-purgative regimen the evening before CE (CS); Citramag + senna + 10 mg metoclopramide before the procedure (CSTM). Main Outcome Measurements: Gastric transit time (GTT) and small-bowel transit time (SBTT), completion rates (CR), view quality, and patient acceptability. Secondary outcome measures positive findings, diagnostic yield. Results: No significant difference was noted among groups for GTT (median [minutes] M, CS, and CSM vs S: 17.3, 24.7, and 15.1 minutes vs 16.8 minutes, respectively; P = .62, M and .30, respectively), SBTT (median [minutes] M, CS, and CSM vs S: 260, 241, and 201 vs 278, respectively; P = .91, .81., and .32, respectively), or CRs (85%, 85%, and 88% vs 89% for M, CS, and CSM vs S, respectively; P = .74, .74, and 1.00, respectively). There was no significant difference in view quality among groups (of 44: 38, 37, and 40 vs 37 for M, CS, and CSM, vs S, respectively; P =.18, .62, and .12, respectively). Diagnostic yield was similar among the groups. CS and CSM regimens were significantly less convenient (P <.001), and CS was significantly less comfortable (P =.001.) than standard preparation. Conclusions: Bowel purgatives and prokinetics do not improve CRs or view quality at CE, and bowel purgatives reduce patient acceptability (Gastrointest Endosc 2009;69:1120-8.)