The Visibility and Performance of Small Bowel Video Capsule Endoscopy With and Without Pre-Procedural Purge Preparation in the Same Patients

Abstract

Background: Small bowel (SB) video capsule endoscopy (VCE) is an established diagnostic tool for the investigation of SB pathologies. Despite clinical studies and a few meta-analyses, an area of continuing controversy is the role of pre-procedural bowel preparation.

Objectives: We compared the visibility and performance of VCE with and without purge preparation in the same patients.

Design: Post hoc analysis of randomized control trial.

Methods: This is a post hoc analysis of the prospective randomized CURE-CD Trial (Comprehensive individUalized pRoactive ThErapy of Crohn's Disease trial). Established Crohn's disease (CD) patients in clinical remission were enrolled and classified into two groups according to relapse risk assessment. All patients are followed up in our clinic and undergo laboratory tests every 3 months and serial VCE studies every 6 months. The first VCE is done after bowel preparation with a clear liquid diet, PEG, and laxative, whereas the subsequent VCEs, when disease is confined to SB only, are done after a day on clear liquid diet. The VCE visibility is rated (1-4 points) by a blind observer, unaware to the preparation regimen.

Results: Forty patients who underwent at least two VCEs, at baseline and after 6 months were included. Visibility scores were similar in these two time points (3.15 vs. 3.10, p = 0.8). Among the low-risk patients' group (n = 16) in whom the clinical parameters (CDAI, CRP, and fecal calprotectin) have not changed significantly during this period, Inflammatory scores assessed by the capsule Lewis score (LS) and PillCam-CD score (PCDS) were similar (median LS 225 vs. 225, p = 0.87, median PCDS 4 vs. 2, p = 0.37).

Conclusion: The visibility and performance of SB VCE for monitoring Crohn's disease is not significantly influenced by purge preparation.

Trial registration: Clinicatrials.gov identifier: NCT03555058.

Keywords: Crohn's disease; bowel preparation; video capsule endoscopy; visibility.