Clinical utility of purgative bowel preparation before capsule endoscopy: a multicenter, blinded, randomized controlled trial,Gastrointestinal Endoscopy

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Clinical utility of purgative bowel preparation before capsule endoscopy: a multicenter, blinded, randomized controlled trial
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2022-07-16 , DOI: 10.1016/j.gie.2022.07.010
Mehul Lamba ₁ , Kimberley Ryan ₁ , Jason Hwang ₁ , Florian Grimpen ₁ , Gary Lim ₂ , Dale Cornelius ₂ , Alan Moss ₃ , Eu Jin Lim ₃ , Gregor Brown ₄ , Nam Nguyen ₅ , Marcus Tippett ₅ , Andrew Taylor ₆ , Mark Appleyard ₁

Affiliation

Background and Aims

Optimal bowel preparation before capsule endoscopy (CE) is currently unknown. In this multicenter, blinded, randomized controlled trial, we assessed clinical effectiveness of 2 types of purgative regimen and a control arm of clear fluid only.

Methods

Patients with suspected small intestinal bleeding were randomized into 3 arms: arm A, clear fluids only for 18 hours before CE and simethicone 200 mg in 150 mL water immediately before CE; arm B, same as A + 2 L of polyethylene glycol (PEG) 12 hours before CE; and arm C, same as A + 1 L PEG + sodium ascorbate 3 hours before CE. To assess diagnostic yield, lesions were classified either as highly relevant (P2) or less relevant (P0 or P1) lesions. Small-bowel visualization quality (SBVQ) was assessed using the Brotz score. Patient tolerability was assessed using the visual analog scale (0-10, with lower scores indicating better tolerability).

Results

Two hundred twenty-nine patients completed the study. The mean age was 58.7 years (95% confidence interval, 29.3-87.9), and 47.2% were men. There was no significant difference in diagnosis of P2 lesions in arms A, B, and C (48.7%, 48.0%, and 45.9%, respectively; P = .94). Overall SBVQ and distal SBVQ were similar across the 3 arms (P = .94 and P = .68, respectively). Patients reported better tolerability in arm A (mean score, 1.5) compared with arms B and C (mean score, 3.5 and 2.6, respectively; P < .001).

Conclusions

The use of a purgative bowel preparation before CE does not improve diagnostic yield or small-bowel visualization and is associated with lower patient tolerance. (Clinical trial registration number: ACTRN 12614000883617.)

中文翻译：

胶囊内镜检查前肠道准备的临床应用：一项多中心、盲法、随机对照试验

背景和目标

目前尚不清楚胶囊内镜检查 (CE) 前的最佳肠道准备。在这项多中心、盲法、随机对照试验中，我们评估了 2 种类型的泻药方案和仅使用清液的对照组的临床有效性。

方法

疑似小肠出血的患者被随机分为 3 组：A 组，CE 前 18 小时内只喝清液体，CE 前立即将 200 毫克西甲硅油溶于 150 毫升水中；臂 B，与CE 前 12 小时的 A + 2 L 聚乙二醇 (PEG) 相同；和臂 C，与CE 前 3 小时的 A + 1 L PEG +抗坏血酸钠相同。为了评估诊断率，病变被分类为高度相关（P2）或不太相关（P0或P1）病变。使用 Brotz 评分评估小肠可视化质量 (SBVQ)。使用视觉模拟量表（0-10，分数越低表示耐受性越好）评估患者的耐受性。

结果

229 名患者完成了研究。平均年龄为 58.7 岁（95% 置信区间，29.3-87.9），47.2% 为男性。A、B 和 C 组的 P2 病变诊断无显着差异（分别为 48.7%、48.0% 和 45.9%；P = .94）。3 组的总体 SBVQ 和远端 SBVQ 相似（分别为P = .94 和P = .68）。患者报告称，A 组的耐受性（平均分 1.5）优于 B 组和 C 组（平均分分别为 3.5 和 2.6；P < .001）。