Small Bowel Purgative Does Not Improve Diagnostic Yield of SBCE for Small Bowel Bleeding

3d rendering x-ray capsule endoscopy isolated on black
Investigators compared the efficacy of clear liquid diet with different polyethylene glycol-based bowel preparation methods in patients with small bowel bleeding.

A purgative preparation before small bowel capsule endoscopy (SBCE) may improve visualization of the mucosa without increasing the number of lesions in patients with suspected small bowel bleeding (SBB), researchers reported in the American Journal of Gastroenterology.

The prospective, multicenter, randomized controlled trial compared a clear liquid diet with 2 different polyethylene glycol (PEG)-based bowel preparation methods for diagnostic yield of SBCE in consecutive patients who underwent SBCE for SBB from September 2010 to February 2016 in France.

The participants were randomly assigned to a preparation of only clear fluids and fasting after 10 PM the day before SBCE ingestion (prep 1), the standard regimen plus 500 mL PEG 30 minutes after SBCE ingestion (prep 2), or the standard regimen plus 2 L PEG the day before SBCE plus 500 mL PEG 30 minutes after SBCE ingestion (prep 3). The primary outcome was detection of ≥1 clinically significant lesions, defined as a P1 or P2 lesion, in the small bowel.

A total of 858 patients were included in the analysis. Their mean age was 61.4±15.6 years, and 53.4% of the patients were women.

No significant difference was found in the primary outcome among the prep 1 (40.5%), prep 2 (40.2%), and prep 3 (38.5%) groups (P =1.0). P1 or P2 lesions occurring in the distal small bowel were not significantly different among the groups, with at least 1 lesion occurring in 2.7%, 5.6%, and 3.1% of patients in the prep 1, prep 2, and prep 3 groups, respectively (P =.172).

The quantitative index of small bowel cleansing was increased in the prep 2 group (8.6±2.1; P <.001) and in the prep 3 group (8.7±1.9; P <.001), compared with the prep 1 (7.3±2.6) group.

For patients in groups who required a purgative, compliance was better in the prep 2 group (86.5%) vs the prep 3 group (83.0%) among those who received 100% of the preparation. Regarding tolerance of the preparation, 61.8% of patients in the prep 2 group reported no symptoms vs 49.8% in the prep 3 group; pronounced discomfort was reported in 1.7% of patients in the prep 2 group compared with 8.7% in the prep 3 group.

Study limitations include the absence of simethicone, and a lack of assessment of tolerance to the standard regimen, which prevented a comparison of this modality with the other groups.

“Liquid diet could be proposed to patients undergoing [SBCE] for suspected SBB,” the investigators commented. “Further relevant studies are warranted on the use of PEG boost and its effect on lesion detection and intrareader and interreader reliability.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures


Rahmi G, Cholet F, Gaudric M, et al. Effect of different modalities of purgative preparation on the diagnostic yield of small bowel capsule for the exploration of suspected small bowel bleeding: a multicenter randomized controlled trial. Am J Gastroenterol. 2022;117(2):327-335. doi: 10.14309/ajg.0000000000001597