Estevinho Maria Manuela, Sarmento Costa Mara, Franco Rita, Pestana Inês, Marílio Cardoso Pedro, Archer Sara, Canha Maria Inês, Correia João, Mesquita Pedro, Roque Ramos Lídia, Rodrigues Adélia, Gomes Catarina, Lopes Sandra, Pinho Rolando
Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia Espinho, Vila Nova de Gaia, Portugal; Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.
Department of Gastroenterology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
Gastrointest Endosc. 2025 Apr;101(4):856-865.e3. doi: 10.1016/j.gie.2024.07.012. Epub 2024 Jul 22.
Current guidelines recommend bowel preparation before small-bowel capsule endoscopy (SBCE). However, the optimal protocol is yet to be defined. To determine the best timing for preparation in SBCE, we compared small-bowel visualization quality (SBVQ), diagnostic yield (DY), and patient-reported outcomes across 4 purgative regimens.
In this prospective, randomized (1:1:1:1), multicenter study, patients with suspected small-bowel bleeding were randomized into 4 arms: G1 (1 L of polyethylene glycol + ascorbic acid [Moviprep, Norgine, Amsterdam, The Netherlands] the night before SBCE), G2 (1 L in the morning up to 2 hours before SBCE), G3 (0.5 L up to 2 hours before SBCE + 0.5 L after the capsule reached the duodenum), and G4 (1 L after the capsule reached the duodenum). To assess DY, lesions were categorized as having high (P2) or low (P0 or P1) bleeding potential. SBVQ was assessed using the Brotz score. Transit times were measured, and patient tolerability was scored from 0 to 5, with higher scores indicating better tolerability.
A total of 387 patients were included, 59% female and with a median age of 73 years (interquartile range, 23). The examination completion rate was lower in G1 (90%, P < .001). Small-bowel transit time was shorter for patients receiving purgative during SBCE (G3 and G4, P = .001). SBVQ was better in patients receiving purgative after reaching the small bowel (P < .001): a median of 7 for G1, 8 for G2, and 9 for G3 and G4. The overall DY of patients receiving intraprocedure purgatives (G3 + G4) was superior (42.7 vs 31.3%, P = .02); significant differences were found in the second and third terciles. Likewise, G3 and G4 had higher angioectasia detection (P = .04). Patients' satisfaction was significantly superior for G4 (median, 4 points; interquartile range, 1).
The group that received the bowel preparation the night before SBCE had poorer outcomes. Intraprocedure purgative regimens reduced SBTT, enhanced visualization, improved DY, and increased angioectasia detection. G4 was the best-tolerated regimen.
当前指南推荐在小肠胶囊内镜检查（SBCE）前进行肠道准备。然而，最佳方案尚未确定。为确定SBCE准备的最佳时机，我们比较了4种泻药方案的小肠可视化质量（SBVQ）、诊断率（DY）和患者报告的结果。
在这项前瞻性、随机（1:1:1:1）、多中心研究中，疑似小肠出血的患者被随机分为4组：G1组（SBCE前一晚服用1升聚乙二醇+抗坏血酸[Moviprep，Norgine，阿姆斯特丹，荷兰]），G2组（SBCE前2小时内的上午服用1升），G3组（SBCE前2小时内服用0.5升+胶囊到达十二指肠后服用0.5升），G4组（胶囊到达十二指肠后服用1升）。为评估DY，病变被分类为具有高（P2）或低（P0或P1）出血潜力。使用Brotz评分评估SBVQ。测量转运时间，患者耐受性从0到5评分，分数越高表明耐受性越好。
共纳入387例患者，59%为女性，中位年龄73岁（四分位间距，23）。G1组的检查完成率较低（90%，P <.001）。在SBCE期间接受泻药的患者小肠转运时间较短（G3组和G4组，P =.001）。到达小肠后接受泻药的患者SBVQ更好（P <.001）：G1组中位数为7，G2组为8，G3组和G4组为9。术中接受泻药治疗的患者（G3 + G4）总体DY更高（42.7%对31.3%，P =.02）；在第二和第三个三分位数中发现显著差异。同样，G3组和G4组的血管扩张检测率更高（P =.04）。G4组患者的满意度显著更高（中位数，4分；四分位间距，1）。
在SBCE前一晚进行肠道准备的组效果较差。术中泻药方案缩短了SBTT，增强了可视化，提高了DY，并增加了血管扩张检测。G4组是耐受性最好的方案。
