Capsule endoscopy and bowel preparation with oral sodium phosphate: a prospective randomized controlled trial

BackgroundCapsule endoscopy (CE) is the first procedure to explore the small bowel in obscure GI bleeding (OGB).ObjectiveTo evaluate the role of bowel preparation with oral sodium phosphate (NaP) in this indication.DesignA prospective multicenter, controlled, randomized, blind study.MethodsA total of 129 patients with the diagnosis of OGB were included and were randomized into 2 groups (group A [n = 64] and group B [n = 63]). In group A, a CE was performed after an 8-hour fasting period. In group B, patients were asked to drink 2 doses of 45 mL NaP before swallowing the capsule. The quality of the images was assessed at 5 different locations of the small bowel. Bowel cleanliness and visibility were evaluated by using 2 scoring systems, which included assessing the presence of bubbles, liquid, and the rate of visibility.ResultsA total of 127 patients (53 men; mean age 56.9 years, range 19-90 years) were analyzed for the preparation and detection of lesions (2 patients were not able to swallow the capsule). No difference was observed for cleanliness and visibility between the 2 groups at any of the small-bowel segments; no difference was found for gastric transit time (39.8 minutes vs 35.7 minutes, P = .63), small-bowel transit time (257.5 minutes vs 248.6 minutes, P = .59), and the detection of lesions (35.9% vs 42.8%, P = .54).LimitationsThe evaluation of bowel cleanliness was based on subjective features.ConclusionsThe results of the present study, despite a significant number of limitations, did not support that small-bowel preparation with oral NaP can be recommended for CE exploration in patients with OGB.