Capsule endoscopy and bowel preparation with oral sodium phosphate: a prospective randomized controlled trial

Background: Capsule endoscopy (CE) is the first procedure to explore the small bowel in obscure GI bleeding (OGB). Objective: To evaluate the role of bowel preparation with oral sodium phosphate (NaP) in this indication. Design: A prospective multicenter, controlled, randomized, blind study. Methods: A total of 129 patients with the diagnosis of OGB were included and were randomized into 2 groups (group A [n = 64] and group B [n = 63]). In group A, a CE was performed after an 8-hour fasting period. In group B, patients were asked to drink 2 doses of 45 mL NaP before swallowing the capsule. The quality of the images was assessed at 5 different locations of the small bowel. Bowel cleanliness and visibility were evaluated by using 2 scoring systems, which included assessing the presence of bubbles, liquid, and the rate of visibility. Results: A total of 127 patients (53 men; mean age 56.9 years, range 19-90 years) were analyzed for the preparation and detection of lesions (2 patients were not able to swallow the capsule). No difference was observed for cleanliness and visibility between the 2 groups at any of the small-bowel segments; no difference was found for gastric transit time (39.8 minutes vs 35.7 minutes, P =.63), small-bowel transit time (257.5 minutes vs 248.6 minutes, P =.59), and the detection of lesions (35.9% vs 42.8%, P = .54). Limitations: The evaluation of bowel cleanliness was based on subjective features. Conclusions: The results of the present study, despite a significant number of limitations, did not support that small-bowel preparation with oral NaP can be recommended for CE exploration in patients with OGB.