Purgative bowel cleansing combined with simethicone improves capsule endoscopy imaging

AIM: To evaluate the effects of the various methods of small bowel preparation on the quality of visualization of the small bowel and the gastrointestinal transit time of capsule endoscopy (CE). METHODS: Ninety patients referred for CE were prospectively randomized to three equal groups according to the preparation used: (a) a control group, in which patients were requested to drink 1 L of clear liquids only, 12 h before the examination; (b) a purgative group, in which patients were requested to ingest 1 L of a polyethylene glycol (PEG)/electrolyte solution only, 12 h before the examination; or (c) a purgative combined with simethicone group (P-S group), in which patients were requested to ingest 1 L of PEG, 12 h before the examination, and 300 mg of simethicone, 20 min before the examination. Effects of the different bowel preparations on the gastric transit time (GTT), small bowel transit time (SBTT), examination completion rate, quality of images of the entire small intestine, and cleansing of the proximal small bowel and distal ileum were evaluated. RESULTS: The number of patients with adequate cleansing of the entire small intestine was 17 in the P-S group, 12 in the purgative group, and seven in the control group (P = 0.002). The P-S group had significantly better image quality than the control group (P = 0.001). The P-S group had significantly better image quality for the proximal small bowel (segment A [Seg A]) than the control group (P = 0.0001). Both the P-S group (P= 0.0001) and the purgative group (P = 0.0002) had significantly better image quality for the distal ileum (segment B [Seg B]) than the control group; the P-S group had significantly better image quality than the purgative group as well (P = 0.0121). Gastrointestinal transit time was not different among the three groups, nor was the examination completion rate. CONCLUSIONS: Purgative bowel cleansing combined with simethicone before CE improved the quality of imaging of the entire small bowel as well as the visualization of the mucosa in the proximal and distal small intestine.