Low-volume bowel preparation provides safe and effective pan-enteric capsule endoscopy in suspected or established Crohn’s disease

BACKGROUND Effective pan-enteric capsule endoscopy (PCE) visualization requires thorough bowel preparation. We hypothesized that a novel low-volume protocol (LVP) provides comparable safety and effectiveness to the standard high-volume protocol (HVP). AIM To evaluate the safety and effectiveness of a novel low-volume vs standard high-volume preparation protocol for PCE. METHODS We conducted an observational study including all prospectively documented PCEs at our tertiary center (2018-2021), comparing preparation adequacy and completion rates between patients receiving LVP vs HVP. Preparation adequacy was evaluated by two blinded expert readers (Cohen’s kappa, correlation tests). Finally, an individual participant data meta-analysis combining our cohort with three published cohorts assessed PCE outcomes with HVP vs LVP. A P value < 0.05 was considered statistically significant in all tests. RESULTS Our analysis included 67 patients: 12 (17.9%) underwent PCE with HVP, and 55 (82.1%) with LVP. No post-PCE complications were reported. PCE completion was achieved by 89.1% of the LVP group and 75.0% of the HVP group. Adequate small bowel and colonic preparation rates were comparable between the HVP and LVP groups (90.9% vs 89.1%, and 80.0% vs 90.0%, respectively). In our individual patient data meta-analysis, the combined HVP (n = 257) and the LVP (n = 55) were comparable regarding completion rates (87.2% vs 89.1%) and adequate small bowel preparation rates (90.0% vs 89.1%); however, LVP had higher rates of adequate colonic preparation vs combined HVP (80.0% vs 62.7%, respectively, P = 0.017). CONCLUSION LVP is a safe and effective alternative to HVP with similar completion rates, better colonic preparation, and lower volume, making it preferable for patients with suspected or diagnosed Crohn’s disease.