Document Detail


Are bowel purgatives and prokinetics useful for small-bowel capsule endoscopy? A prospective randomized controlled study.
MedLine Citation:
PMID:  19152909     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Capsule endoscopy (CE) is limited by incomplete small-bowel transit and poor view quality in the distal bowel. Currently, there is no consensus regarding the use of bowel purgatives or prokinetics in CE. OBJECTIVE: To evaluate the usefulness of bowel purgatives and prokinetics in small-bowel CE. DESIGN: Prospective single-blind randomized controlled study. SETTING: Academic endoscopy unit. PATIENTS: A total of 150 patients prospectively recruited. INTERVENTION: Patients were randomized to 1 of 4 preparations: "standard" (fluid restriction then nothing by mouth 12 hours before the procedure, water and simethicone at capsule ingestion [S]); "standard" + 10 mg oral metoclopramide before the procedure (M); Citramag + senna bowel-purgative regimen the evening before CE (CS); Citramag + senna + 10 mg metoclopramide before the procedure (CSM). MAIN OUTCOME MEASUREMENTS: Gastric transit time (GTT) and small-bowel transit time (SBTT), completion rates (CR), view quality, and patient acceptability. Secondary outcome measures: positive findings, diagnostic yield. RESULTS: No significant difference was noted among groups for GTT (median [minutes] M, CS, and CSM vs S: 17.3, 24.7, and 15.1 minutes vs 16.8 minutes, respectively; P = .62, .18, and .30, respectively), SBTT (median [minutes] M, CS, and CSM vs S: 260, 241, and 201 vs 278, respectively; P = .91, .81, and .32, respectively), or CRs (85%, 85%, and 88% vs 89% for M, CS, and CSM vs S, respectively; P = .74, .74, and 1.00, respectively). There was no significant difference in view quality among groups (of 44: 38, 37, and 40 vs 37 for M, CS, and CSM, vs S, respectively; P = .18, .62, and .12, respectively). Diagnostic yield was similar among the groups. CS and CSM regimens were significantly less convenient (P < .001), and CS was significantly less comfortable (P = .001) than standard preparation. CONCLUSIONS: Bowel purgatives and prokinetics do not improve CRs or view quality at CE, and bowel purgatives reduce patient acceptability.
Authors:
Aymer Postgate; Paris Tekkis; Neil Patterson; Aine Fitzpatrick; Paul Bassett; Chris Fraser
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2009-01-18
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  69     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-04     Completed Date:  2009-08-06     Revised Date:  2010-09-03    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1120-8     Citation Subset:  IM    
Affiliation:
Wolfson Unit for Endoscopy, St. Mark's Hospital, Imperial College London, UK. apostgate@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Capsule Endoscopy / methods*
Cathartics / administration & dosage*,  adverse effects
Citric Acid / administration & dosage*
Drug Administration Schedule
Drug Combinations
Drug Therapy, Combination
Female
Gastrointestinal Motility / drug effects*
Gastrointestinal Transit / drug effects*
Humans
Intestinal Diseases / diagnosis*
Intestine, Small* / drug effects
Magnesium / administration & dosage*,  adverse effects
Male
Metoclopramide / administration & dosage*,  adverse effects
Middle Aged
Premedication
Prospective Studies
Senna Extract / administration & dosage*,  adverse effects
Simethicone / administration & dosage*,  adverse effects
Single-Blind Method
Young Adult
Chemical
Reg. No./Substance:
0/Cathartics; 0/Drug Combinations; 364-62-5/Metoclopramide; 546-93-0/magnesium carbonate; 7439-95-4/Magnesium; 77-92-9/Citric Acid; 8013-11-4/Senna Extract; 8050-81-5/Simethicone
Comments/Corrections
Comment In:
Gastrointest Endosc. 2010 Sep;72(3):670-1; author reply 671   [PMID:  20801296 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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