aDivision of Gastroenterology bDepartment of Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois, USA.
Eur J Gastroenterol Hepatol. 2014 Feb;26(2):137-45. doi: 10.1097/MEG.0b013e328365b9d4.
The ideal bowel preparation regime before small bowel video capsule endoscopy (VCE) is not known. We carried out a systematic review and meta-analysis to study the effect of purgatives, antifoaming agents, and prokinetics on the outcomes associated with VCE.
We performed literature searches in MEDLINE and Cochrane Library and included randomized-controlled trials studying the effect of purgatives, antifoaming agents, and prokinetics in patients undergoing VCE. Our outcomes of interest were visualization quality, diagnostic yield, and completion rate. Meta-analyses were carried out using the RevMan software and heterogeneity was assessed using the I statistic.
Fifteen studies fulfilled the inclusion criteria. As compared with no bowel preparation, bowel preparation with polyethylene glycol (PEG) led to adequate visualization in a significantly higher number of patients undergoing VCE [odds ratio (OR) 3.13; 95% confidence interval (CI) 1.70-5.75]. Both PEG and sodium phosphate significantly improved the diagnostic yield (OR 1.68; 95% CI 1.16-2.42 and OR 1.77; 95% CI 1.18-2.64, respectively) but did not affect the completion rate. All studies with simethicone showed significantly improved visualization quality with its use as compared with overnight fasting or purgatives alone. Prokinetics did not significantly improve the completion rate of VCE.
On the basis of the data available, a combination of PEG and simethicone appears to be the best approach for small bowel preparation before VCE. However, large multicenter randomized-controlled trials are needed to validate this recommendation and to evaluate the ideal dose of PEG and timing of bowel preparation before VCE. Prokinetics administered before VCE do not improve the completion rate and should not be used.
小肠胶囊内镜（VCE）前的理想肠道准备方案尚不清楚。我们进行了系统评价和荟萃分析，以研究泻药、消泡剂和促动力药对 VCE 相关结果的影响。
我们在 MEDLINE 和 Cochrane 图书馆进行了文献检索，并纳入了研究 VCE 患者中泻药、消泡剂和促动力药效果的随机对照试验。我们感兴趣的结局是可视化质量、诊断率和完成率。使用 RevMan 软件进行荟萃分析，并使用 I 统计评估异质性。
15 项研究符合纳入标准。与无肠道准备相比，PEG 肠道准备使 VCE 患者中获得充分可视化的患者数量显著增加[比值比（OR）3.13；95%置信区间（CI）1.70-5.75]。PEG 和磷酸钠均显著提高了诊断率（OR 1.68；95%CI 1.16-2.42 和 OR 1.77；95%CI 1.18-2.64），但不影响完成率。所有使用二甲硅油的研究均显示，与单独夜间禁食或泻药相比，其使用可显著改善可视化质量。促动力药并不能显著提高 VCE 的完成率。
根据现有数据，PEG 和二甲硅油的联合应用似乎是 VCE 前小肠准备的最佳方法。然而，需要进行大型多中心随机对照试验来验证这一建议，并评估 VCE 前 PEG 的理想剂量和肠道准备时间。在 VCE 前使用促动力药不能提高完成率，不应使用。
