Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Guimarães, Portugal.
School of Medicine, Life and Health Sciences Research Institute, University of Minho, Braga, Guimarães, Portugal.
Dig Dis Sci. 2023 Dec;68(12):4418-4431. doi: 10.1007/s10620-023-08133-7. Epub 2023 Oct 13.
The rate of adequate cleansing (ACR) and complete examinations (CR) are key quality indicators in capsule colonoscopy (CC) and pan-intestinal capsule endoscopy (PCE).
To evaluate the efficacy of bowel preparation protocols regarding ACR and CR.
We conducted a systematic review and meta-analysis, search terms regarding colon capsule preparation, publication date from 2006/01, and date of search 2021/12, in six bibliographic databases. Multiple steps of the cleansing protocol were assessed: diet, adjunctive laxatives, purgative solution, use of prokinetic agents, and "booster". The meta-analytical frequency of ACR and CR was estimated, and subgroup analyses performed. Strategies associated with higher ACR and CR were explored using meta-analytical univariable and multivariable regression models.
Twenty-six observational studies and five RCTs included (n = 4072 patients). The pooled rate of ACR was 72.5% (95% C.I. 67.8-77.5%; I = 92.4%), and the pooled rate of CR was 83.0% (95% C.I. 78.7-87.7%; I = 96.5%). The highest ACR were obtained using a low-fibre diet [78.5% (95% C.I. 72.0-85.6%); I = 57.0%], adjunctive laxatives [74.7% (95% C.I. 69.8-80.1%); I = 85.3%], and split dose < 4L polyethylene glycol (PEG) as purgative [77.5% (95% C.I. 68.4-87.8%); I = 47.3%]. The highest CR were observed using routine prokinetics prior to capsule ingestion [84.4% (95% C.I. 79.9-89.2%); I = 89.8%], and sodium phosphate (NaP) as "booster" [86.2% (95% C.I. 82.3-90.2%); I = 86.8%]. In univariable models, adjunctive laxatives were associated with higher ACR [OR 1.81 (95% C.I. 1.13; 2.90); p = 0.014]. CR was higher with routine prokinetics [OR 1.86 (95% C.I. 1.13; 3.05); p = 0.015] and split-dose PEG purgative [OR 2.03 (95% C.I. 1.01; 4.09), p = 0.048].
Main quality outcomes (ACR, CR) remain suboptimal for CC and PCE. Despite considerable heterogeneity, our results support low-fibre diet, use of adjunctive sennosides, split dose < 4L PEG, and routine prokinetics, while NaP remains the most consistent option as booster.
胶囊结肠镜检查（CC）和全肠道胶囊内镜检查（PCE）的充分清洗（ACR）和完整检查（CR）率是关键的质量指标。
评估肠道准备方案对 ACR 和 CR 的疗效。
我们进行了系统评价和荟萃分析，检索了 2006 年 1 月至 2021 年 12 月期间关于结肠胶囊准备的文献，并在六个文献数据库中进行了搜索。评估了多个肠道准备方案步骤：饮食、辅助性泻药、泻药溶液、使用促动力药物和“助推剂”。估计了 ACR 和 CR 的荟萃分析频率，并进行了亚组分析。使用荟萃分析单变量和多变量回归模型探讨了与更高 ACR 和 CR 相关的策略。
共纳入 26 项观察性研究和 5 项 RCT（n=4072 例患者）。ACR 的汇总率为 72.5%（95%CI 67.8-77.5%；I=92.4%），CR 的汇总率为 83.0%（95%CI 78.7-87.7%；I=96.5%）。使用低纤维饮食（78.5%（95%CI 72.0-85.6%）；I=57.0%）、辅助性泻药（74.7%（95%CI 69.8-80.1%）；I=85.3%）和<4L 聚乙二醇（PEG）分剂量（77.5%（95%CI 68.4-87.8%）；I=47.3%）可获得最高的 ACR。常规使用促动力药物（84.4%（95%CI 79.9-89.2%）；I=89.8%）和使用磷酸钠（NaP）作为“助推剂”（86.2%（95%CI 82.3-90.2%）；I=86.8%）可获得最高的 CR。在单变量模型中，辅助性泻药与更高的 ACR 相关（OR 1.81（95%CI 1.13；2.90）；p=0.014）。CR 随着常规促动力药物（OR 1.86（95%CI 1.13；3.05）；p=0.015）和 PEG 分剂量（OR 2.03（95%CI 1.01；4.09），p=0.048）的使用而升高。
CC 和 PCE 的主要质量结果（ACR、CR）仍然不理想。尽管存在很大的异质性，但我们的结果支持低纤维饮食、使用辅助性番泻叶、<4L PEG 分剂量和常规使用促动力药物，而 NaP 仍然是最一致的“助推剂”选择。
