Overnight Fasting only or Polyethylene Glycol Preparation for Capsule Endoscopy for detection of the Source of Overt Suspected Small Bowel Bleeding： a retrospective study

Background: Small bowel capsule endoscopy (SBCE) is recommended as the first choice of small bowel evaluation for suspected small bowel bleeding (SBB). However, there is no consensus on the cleansing criteria prior to SBCE. Aim We aimed to assess the effectiveness of the purgative regimen and the overnight fasting only method before undergoing SBCE. Methods This was a retrospective study of 102 patients who underwent SBCE to detect the source of active or sub-acute overt suspected SBB. 63 Patients in Group A consumed 2 L of PEG (Polyethylene glycol) before SBCE after an overnight fast; whereas 39 patients in Group B performed 12 hours overnight fast before the procedure. The primary endpoint was lesion findings and diagnostic yield, and the secondary endpoints were clinical outcomes, capsule endoscopy completion rate (CECR), transit time and the small bowel visualization quality (VQ). RESULTS The positive finding was ascertained in 38 patients in Group A (60.3%), and 18 in Group B (46.2%; P = 0.162). There was no significant difference in diagnosis yield in 2 groups (47.6% vs. 51.3%; P = 0.719), the same as the sensitivity (53.6% vs. 58.8%; P = 0.627) and specificity (71.4% vs. 100%; P = 0.470). The percentage of excellent or good small bowel VQ in Group A was significantly more than in Group B (57.2% vs. 38.5%, P = 0.0012). The median small-bowel transit time for Group A was statistically significant shorter than Group B (400 min vs. 519 min; P = 0.01). No evidence of differences was detected between the two groups in further treatment methods and prognosis(P = 0.209). CONCLUSION 2L PEG-based bowel preparation before SBCE does not result in improvement of diagnostic yield or clinical outcomes, although the small bowel visualization quality is enhanced.