Is There a Method to Improve Examination of the Small Bowel With Capsule Endoscopy?

The ability of video capsule endoscopy (VCE) to detect small-bowel (SB) pathology is dependent on adequate visibility and motility. This single-center, prospective, randomized, controlled trial aimed to compare the VCE image quality and diagnosis of SB pathology in a group that underwent the diving method versus a control group. Secondary outcomes included the examination completion rate, gastric transit time (GTT), small-bowel transit time (SBTT), lesion detection rate, adverse events, and patient satisfaction. 

For the study, 140 eligible patients were randomly assigned to the diving group (n=64) or the control group (n=76). Both groups were instructed to fast for 12 hours, drink 1 L of polyethylene glycol-electrolyte solution the evening before and the morning of the examination, and receive 10 cc of simethicone 10 minutes before capsule ingestion. In addition, once the capsule reached the SB in patients randomized to the diving group, 500 mL of water was administered every hour until the capsule made it to the colon or powered off. Two blinded independent reviewers interpreted the images.

The endoscopic image scores reflective of image quality in the proximal and middle thirds of the SB in the diving group were significantly higher than that in the control group (3.47 ± 0.60 vs 3.11 ± 0.63, P=.007; 3.24 ± 0.59 vs 2.78 ± 0.74, P=.002, respectively). Interestingly, although there was no difference in the quality of images of the distal third of the SB, detection of positive findings was significantly higher in the diving group (P=.005). Additionally, the completion rate in the diving group was significantly higher (P=.012). The GTTs, SBTTs, and lesion detection rates were similar in the 2 groups. Patients in the diving group did experience more frequent urination.