Bowel preparation with still water for small bowel capsule endoscopy: Less is more

BACKGROUND The optimal bowel preparation for small bowel capsule endoscopy (SBCE) has not been standardized. AIM To compare the rate of complete examinations, quality of bowel preparation, diagnostic yield and tolerability, using three protocols for SBCE. METHODS A prospective, multicentre, randomized study including patients submitted to SBCE was conducted. Patients ingested a booster once the capsule reached the small bowel, randomized into one of three protocols: (1) 1 L of polyethylene glycol (PEG); (2) 1 L of PEG and ascorbic acid; and (3) 1 L of water. The patients’ bowel preparation was evaluated with Small Bowel CLEansing Assessment and Report. RESULTS A total of 261 patients were included, 96 (36.8%) in protocol 1, 93 (35.6%) in protocol 2 and 72 (27.6%) in protocol 3. The rate of complete examinations, adequate bowel preparation and diagnostic yield were comparable among the groups (P = 0.655, P = 0.193 and P = 0.589, respectively). The overall Small Bowel CLEansing Assessment and Report score was similar among the protocols (P = 0.236). Although the preparation of the third tertile had a lower score using protocol 3 (protocol 1: 2.5 ± 0.1 vs 2: 2.6 ± 0.1 vs 3: 2.3 ± 0.1, P = 0.021), it did not compromise the mucosal visualization, maintaining a mean score above 2 and similar diagnostic yield among the protocols (P = 0.850). The patients’ reported tolerability was higher in protocol 3 (protocol 1: 2.8 ± 0.1 vs 2: 3.0 ± 0.2 vs 3: 0.6 ± 0.1, P < 0.001). CONCLUSION Using 1 L of water as a booster in SBCE was better tolerated and associated with comparable rates of complete examinations, adequate bowel preparation and diagnostic yield vs PEG with or without ascorbic acid.