Comparison Of Enteral Nutrition Powder And Low Residue Diet For Bowel Preparation Of Colon Capsule Endoscopy

BackgroundColon capsule endoscopy is a new method for diagnosing colorectal diseases.It is a safe,minimally invasive,easily acceptable examination for inspecting the colon that does not require anesthesia.A study showed that when the subjective underwent CCE,the proportion of patients who felt not at all and almost none for embarrassment,fear,and pain were 95.5%,83.3% and 98.5%,respectively.The US FDA approved CCE as the following procedure for the incomplete colonoscopy.The bowel preparation of CCE has three aims: to clean the colonic mucosa,to make the colon full of clear liquids and to promote the capsule propulsion in the gastrointestinal tract.The previous study showed the accuracy of CCE was closely related to the quality of bowel preparation.When the bowel preparation was adequate,the sensitivity of CCE was increased.Now there was no optimal bowel preparation for CCE.In this context,we aimed to explore a bowel preparation method with adequate colon cleanliness and high acceptance for Chinese.ObjectivesThe purpose of this study was to compare the enteral nutrition powder plus 2L PEG with low residue diet plus 4L PEG for the bowel preparation of CCE.And to evaluate the accuracy of CCE for diagnosing colorectal polyps.MethodsThis is a prospective study including patients at Xijing hospital of digestive disease.Eligible patients were Chinese individuals aged 18-80 years old.They were all underwent a colonoscopy that found colorectal polyps which had a ?6mm polyps or the number of polps was ?3.The colorectal polyps required endoscopic treatment in hospital.Exclusion criteria:1.Dysphagia;2.A cardiac pacemaker or other implanted electromedical devices;3.Pregnant or nursing women;4.Plan to undergo MRI in a week;5.Allergy or contraindication to the drugs used in the study;6.A high risk of capsule retention;7.The physical condition can't carry out the preparation protocol;8.Refuse to sign an informed consent.Bowel preparationThe participants in group A adopted a low residue diet,and then they took split dose of 4 L PEG-ELP in the evening before test day and the morning on the test day.30 minutes before the ingestion of CCE,the subjective took 5 mg mosapride citrate.The boosters in this study were adopted 0.75 L PEG-ELP and 0.5 L PEG-ELP.The participants in group B underwent a different regimen.Participants in this group were received enteral nutritional powder as diet preparation and received 2 L PEG-ELP in the morning on the test day.Other drugs and procedures used for bowel preparation in group B were the same as the group A.Colonoscopy procedureOn the following day of the CCE test,participants underwent a therapeutic endoscopy.Before colonoscopy,participants need to receive 1 L PEG-ELP for bowel preparation.Outcome measuresThe primary outcome was the adequate rate of bowel preparation for the colon capsule endoscopy.Colon cleanliness was evaluated by a four-point grading scale(excellent,good,fair,and poor)in previous study.In this study,a two-point grading scale(adequate,inadequate)was used for assessing the cleanliness of overall colon and each segmental section of the colon.The excellent or good bowel preparation was considered as adequate,while the fair or poor bowel preparation considered asinadequate.The second outcomes in the study include the sensitivity of CCE detecting colorectal polyps,the gastrointestinal and colonic transit time of CCE,the excretion rate of capsule,the acceptability of patients about two bowel preparations,the adverse events and the ability to find extracolonic pathologies.Results Patient characteristicsForty-seven patients were enrolled between January 2014 and February 2017.Of the47 patients,32 underwent the low residue diet(group A),and 15 underwent enteral nutritional powder(group B).The average age of group A and group B was 54.34±13.57 years and 53.13±8.28 years,respectively.The number of male patients of two groups was21 And 12.In group A,the mean BMI and waist circumference of participant was 24.08Kg/m2 and 81.94 cm.And in the group B,the mean BMI and waist circumference was24.45 Kg/m2 and 78.73 cm.All characteristics between the two groups had no significant difference.Outcomes of bowel preparationThe overall cleanliness was considered as adequate in 71%(95% confidence interval[CI],51%-87%)of cases in group A and in 64 %(95% CI,35%-87%)of cases in group B.When analyzed the cleansing level in segments,the adequate rate of cecum was 61%(95% CI,41%-78%)in group A versus 57%(95% CI,29%-82%)in group B.In the ascending colon,cleansing level was adequate in 71%(51%-87%)and 79%(95% CI,49%-95%).In the transverse colon,cleansing level was adequate in 79%(59%-92%)and86%(95% CI,57%-98%).And descending-sigmoid was adequate in 63%(42%-81%)of patients in group A versus 46%(95% CI,25%-81%)in group B.There was nosignificance difference in the colon cleanliness between two groups.CCE detected the colorectal polyps in 37 of 45 patients,so the per-patient sensitivity of CCE was 76%(95% CI,60%-86%).And the sensitivity of CCE in detecting ?10 mm,?6 mm and ?5mm was 81%,74% and 64%,respectively.The mean transit time through the gastrointestinal tract was 11.42±5.23 hours in group A,and 11.90±5.27 hours in group B(P =0.776).The mean colonic transit time of the group A and group B was 7.47±4.75 hours and 6.72±4.79 hours,respectively(P=0.618).The gastrointestinal tract transit time and colonic transit time of two groups had no significant difference.In this study,the proportion of patients in group A and group B who felt the bowel preparation was difficult were 44% and 33%,respectively.18 patients in group A and 10 patients in group B were willianng to choose the previous bowel preparation protocol(56% vs 67%,P=0.498).Compared with colonoscopy,92% of the patients felt comfortable when underwent CCE,and 87% of patients were willing to perform CCE.In this study,there was no severe adverse events.And CCE found small bowel polyps in four patients.Conclusions:1.There was no significant difference between the bowel preparation quality of the enteral nutrition powder plus 2 L PEG-ELP and low residue diet plus 4 L PEG-ELP.2.In the bowel preparation,CCE-2 had good sensitivity in detecting polyps ?10 mm,?6 mm and ?5 mm.3.When used PEG-ELP as boosters for bowel preparation of CCE,it resulted in prolonging gastrointestinal transit time.4.The acceptance rate of bowel preparation in two groups was low,and CCE had higher acceptance rate than colonoscopy.