Semenov Serhiy, Ismail Mohd Syafiq, O'Hara Fintan, Sihag Sandeep, Ryan Barbara, O'Connor Anthony, O'Donnell Sarah, McNamara Deirdre
Gastroenterology Department, Tallaght University Hospital, Dublin D 24, Ireland.
World J Gastrointest Pharmacol Ther. 2021 Nov 5;12(6):103-112. doi: 10.4292/wjgpt.v12.i6.103.
Incomplete excretion rates are problematic for colon capsule endoscopy (CCE). Widely available booster regimens are suboptimal. Recently published data on one day preparation CCE protocol using castor oil appeared effective.
To assess the impact of adding castor oil to a standard split-dose (2-d) preparation in an unselected Western patient cohort.
All patients aged 18 or more referred to our unit for a CCE over a 5-mo period were prospectively recruited. Controls were retrospectively identified from our CCE database. All patients received split bowel preparation with Moviprep [polyethylene glycol (PEG)-3350, sodium sulphate, sodium chloride, potassium chloride, sodium ascorbate and ascorbic acid for oral solution; Norgine B. V, United States], a PEG-based solution used predominantly in our colonoscopy practice. Control booster regimen included Moviprep with 750 mL of water (booster 1) on reaching the small bowel. A further dose of Moviprep with 250 mL of water was given 3 h later and a bisacodyl suppository (Dulcolax) 10 mg after 8 h, if the capsule was not excreted. In addition to our standard booster regimen, cases received an additional 15 mL of castor oil given at the time of booster 1. A nested case control design with 2:1 ratio (control:case) was employed. Basic demographics, completion rates, image quality, colonic transit time, diagnostic yield and polyp detection were compared between groups, using a student or chi-square tests as appropriate.
One hundred and eighty-six CCEs [mean age 60 years (18-97), 56% females, = 104], including 62 cases have been analysed. Indication breakdown included 96 polyp surveillance (51.6%), 42 lower gastrointestinal symptoms (22.6%), 28 due to incomplete colonoscopy (15%), 18 anaemia (9.7%) and 2 inflammatory bowel disease surveillance (1.1%). Overall, CCE completion was 77% (144/186), image quality was adequate/diagnostic in 91% (170/186), mean colonic transit time was 3.5 h (0.25-13), and the polyp detection rate was 57% (106/186). Completion rates were significantly higher with castor oil, 87% cases (54/62) 73% controls (90/124), = 0.01. The number needed to treat with castor oil to result in an additional complete CCE study was 7, absolute risk reduction = 14.52%, 95% confidence interval (CI): 3.06- 25.97. This effect of castor oil on excretion rates was more significant in the over 60 s, < 0.03, and in females, < 0.025. Similarly, polyp detection rates were higher in cases 82% (51/62) controls 44% (55/124), = 0.0001, odds ratio 5.8, 95%CI: 2.77-12.21. Colonic transit times were similar, 3.2 h and 3.8 h, respectively. Image quality was similar, reported as adequate/diagnostic in 90% (56/62) 92% (114/124).
In our capsule endoscopy centre, castor oil addition as a CCE booster significantly improved completion rates and polyp detection in an unselected Western cohort.
结肠胶囊内镜检查（CCE）中排泄不完全的发生率是个问题。广泛使用的增强方案效果欠佳。最近发表的关于使用蓖麻油的一日准备CCE方案的数据似乎有效。
评估在未选择的西方患者队列中，在标准分剂量（2天）准备方案中添加蓖麻油的影响。
前瞻性招募了所有在5个月期间转诊至我科进行CCE检查的18岁及以上患者。从我们的CCE数据库中回顾性确定对照组。所有患者均接受用Moviprep[聚乙二醇（PEG）-3350、硫酸钠、氯化钠、氯化钾、抗坏血酸钠和抗坏血酸口服溶液；美国Norgine B.V公司]进行的分阶段肠道准备，这是一种主要用于我们结肠镜检查实践的基于PEG的溶液。对照增强方案包括在到达小肠时用750 mL水冲服Moviprep（增强剂1）。如果胶囊未排出，3小时后再给予一剂250 mL水冲服的Moviprep，并在8小时后给予10 mg比沙可啶栓剂（杜秘克）。除了我们的标准增强方案外，病例组在增强剂1给药时额外给予15 mL蓖麻油。采用2:1比例（对照：病例）的巢式病例对照设计。使用学生t检验或卡方检验（视情况而定）比较两组之间的基本人口统计学、完成率、图像质量、结肠转运时间、诊断率和息肉检出率。
共分析了186例CCE检查[平均年龄60岁（18 - 97岁），56%为女性，n = 104]，其中包括62例病例。适应证分类包括96例息肉监测（51.6%）、42例下消化道症状（22.6%）、28例因结肠镜检查不完全（15%）、18例贫血（9.7%）和2例炎症性肠病监测（1.1%）。总体而言，CCE完成率为77%（144/186），图像质量在91%（170/186）的检查中足够/可用于诊断，平均结肠转运时间为3.5小时（0.25 - 13小时），息肉检出率为57%（106/186）。使用蓖麻油的完成率显著更高，病例组为87%（54/62），对照组为73%（90/124），P = 0.01。使用蓖麻油导致额外完成一项完整CCE检查所需治疗的人数为7人，绝对风险降低 = 14.52%，95%置信区间（CI）：3.06 - 25.97。蓖麻油对排泄率的这种影响在60岁以上人群中更显著，P < 0.03，在女性中P < 0.025。同样，病例组的息肉检出率更高，为82%（51/62），对照组为44%（55/124），P = 0.0001，优势比为5.8，95%CI：2.77 - 12.21。结肠转运时间相似，分别为3.2小时和3.8小时。图像质量相似，病例组90%（56/62）和对照组92%（114/124）报告为足够/可用于诊断。
在我们的胶囊内镜检查中心，添加蓖麻油作为CCE增强剂可显著提高未选择的西方队列中的完成率和息肉检出率。
