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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(11): E1658-E1673
DOI: 10.1055/a-1529-5814
Review

Efficacy of bowel preparation regimens for colon capsule endoscopy: a systematic review and meta-analysis

Thomas Bjoersum-Meyer
 1   Department of Surgery, Odense University Hospital, Odense Denmark
,
Karolina Skonieczna-Zydecka
 2   Department of Biochemical Sciences, Pomeranian Medical University, Szczecin, Poland
,
Pablo Cortegoso Valdivia
 3   Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy.
,
Irene Stenfors
 4   Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
,
Ivan Lyutakov
 5   Department of Gastroenterology, University Hospital “Tsaritsa Yoanna – ISUL”, Medical University Sofia, Bulgaria
,
Emanuele Rondonotti
 6   Gastroenterology Unit, Valduce Hospital, Como, Italy
,
Marco Pennazio
 7   University Division of Gastroenterology, City of Health and Science University Hospital, Turin, Italy
,
Wojciech Marlicz
 8   Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
 9   The Centre for Digestive Diseases, Endoklinika, Szczecin, Poland
,
Gunnar Baatrup
 1   Department of Surgery, Odense University Hospital, Odense Denmark
,
Anastasios Koulaouzidis
10   Department of Social Medicine & Public Health, Pomeranian Medical University, Szczecin, Poland
,
Ervin Toth
 4   Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
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Abstract

Background and study aims Colon capsule endoscopy (CCE) is an alternative to conventional colonoscopy (CC) in specific clinical settings. High completion rates (CRs) and adequate cleanliness rates (ACRs) are fundamental quality parameters if CCE is to be widely implemented as a CC equivalent diagnostic modality. We conducted a systematic review and meta-analysis to investigate the efficacy of different bowel preparations regimens on CR and ACR in CCE.

Patients and methods We performed a systematic literature search in PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library. Data were independently extracted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The primary outcome measures (CR, ACR) were retrieved from the individual studies and pooled event rates were calculated.

Results Thirty-four observational (OBS) studies (n = 3,789) and 12 randomized clinical trials (RCTs) (n = 1,214) comprising a total 5,003 patients were included. The overall CR was 0.798 (95 % CI, 0.764–0.828); the highest CRs were observed with sodium phosphate (NaP) + gastrografin booster (n = 2, CR = 0.931, 95 % CI, 0.820–0.976). The overall ACR was 0.768 (95 % CI, 0.735–0.797); the highest ACRs were observed with polyethylene glycol (PEG) + magnesium citrate (n = 4, ER = 0.953, 95 % CI, 0.896–0.979).

Conclusions In the largest meta-analysis on CCE bowel preparation regimens, we found that both CRs and ACRs are suboptimal compared to the minimum recommended standards for CC. PEG laxative and NaP booster were the most commonly used but were not associated with higher CRs or ACRs. Well-designed studies on CCE should be performed to find the optimal preparation regimen.

Supplementary material



Publication History

Received: 25 February 2021

Accepted: 04 June 2021

Article published online:
12 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Fireman Z, Kopelman Y. The colon – the latest terrain for capsule endoscopy. Dig Liver Dis 2007; 39: 895-899
    CrossrefPubMedSearch in Google Scholar
  • 2 Wang YC, Pan J, Liu YW. et al. Adverse events of video capsule endoscopy over the past two decades: a systematic review and proportion meta-analysis. BMC Gastroenterol 2020; 20: 364
    CrossrefPubMedSearch in Google Scholar
  • 3 Kjolhede T, Olholm AM, Kaalby L. et al. Diagnostic accuracy of capsule endoscopy compared with colonoscopy for polyp detection: systematic review and meta-analyses. Endoscopy 2020;
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Sieg A. Capsule endoscopy compared with conventional colonoscopy for detection of colorectal neoplasms. World J Gastrointest Endosc 2011; 3: 81-85
    CrossrefPubMedSearch in Google Scholar
  • 5 Leighton JA, Rex DK. A grading scale to evaluate colon cleansing for the PillCam COLON capsule: a reliability study. Endoscopy 2011; 43: 123-127
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62: 1006-1012
    CrossrefPubMedSearch in Google Scholar
  • 7 von Elm E, Altman DG, Egger M. et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453-1457
    CrossrefPubMedSearch in Google Scholar
  • 8 Higgins JP, Altman DG, Gotzsche PC. et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
    CrossrefPubMedSearch in Google Scholar
  • 9 vEgger M, Davey Smith G, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
    CrossrefPubMedSearch in Google Scholar
  • 10 Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455-463
    CrossrefPubMedSearch in Google Scholar
  • 11 Schoofs N, Deviere J, Van Gossum A. PillCam colon capsule endoscopy compared with colonoscopy for colorectal tumor diagnosis: a prospective pilot study. Endoscopy 2006; 38: 971-977
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Van Gossum A, Munoz-Navas M, Fernandez-Urien I. et al. Capsule endoscopy versus colonoscopy for the detection of polyps and cancer. N Engl J Med 2009; 361: 264-270
    CrossrefPubMedSearch in Google Scholar
  • 13 Eliakim R, Yassin K, Niv Y. et al. Prospective multicenter performance evaluation of the second-generation colon capsule compared with colonoscopy. Endoscopy 2009; 41: 1026-1031
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Gay G, Delvaux M, Frederic M. et al. Could the colonic capsule PillCam Colon be clinically useful for selecting patients who deserve a complete colonoscopy? results of clinical comparison with colonoscopy in the perspective of colorectal cancer screening. Am J Gastroenterol 2010; 105: 1076-1086
    CrossrefPubMedSearch in Google Scholar
  • 15 Spada C, Hassan C, Munoz-Navas M. et al. Second-generation colon capsule endoscopy compared with colonoscopy. Gastrointest Endosc 2011; 74: 581-589
    CrossrefPubMedSearch in Google Scholar
  • 16 Herrerias-Gutierrez JM, Arguelles-Arias F, Caunedo-Alvarez A. et al. PillCamColon Capsule for the study of colonic pathology in clinical practice. Study of agreement with colonoscopy. Rev Esp Enferm Dig 2011; 103: 69-75
    CrossrefPubMedSearch in Google Scholar
  • 17 Spada C, Hassan C, Ingrosso M. et al. A new regimen of bowel preparation for PillCam colon capsule endoscopy: a pilot study. Dig Liver Dis 2011; 43: 300-304
    CrossrefPubMedSearch in Google Scholar
  • 18 Rondonotti E, Borghi C, Mandelli G. et al. Accuracy of capsule colonoscopy and computed tomographic colonography in individuals with positive results from the fecal occult blood test. Clin Gastroenterol Hepatol 2014; 12: 1303-1310
    CrossrefPubMedSearch in Google Scholar
  • 19 Hagel AF, Gabele E, Raithel M. et al. Colon capsule endoscopy: detection of colonic polyps compared with conventional colonoscopy and visualization of extracolonic pathologies. Can J Gastroenterol Hepatol 2014; 28: 77-82
    CrossrefPubMedSearch in Google Scholar
  • 20 Triantafyllou K, Viazis N, Tsibouris P. et al. Colon capsule endoscopy is feasible to perform after incomplete colonoscopy and guides further workup in clinical practice. Gastrointest Endosc 2014; 79: 307-316
    CrossrefPubMedSearch in Google Scholar
  • 21 Saito Y, Saito S, Oka S. et al. Evaluation of the clinical efficacy of colon capsule endoscopy in the detection of lesions of the colon: prospective, multicenter, open study. Gastrointest Endosc 2015; 82: 861-869
    CrossrefPubMedSearch in Google Scholar
  • 22 Rex DK, Adler SN, Aisenberg J. et al. Accuracy of capsule colonoscopy in detecting colorectal polyps in a screening population. Gastroenterology 2015; 148: 948-957 e942
    CrossrefPubMedSearch in Google Scholar
  • 23 Spada C, Hassan C, Barbaro B. et al. Colon capsule versus CT colonography in patients with incomplete colonoscopy: a prospective, comparative trial. Gut 2015; 64: 272-281
    CrossrefPubMedSearch in Google Scholar
  • 24 Togashi K, Fujita T, Utano K. et al. Gastrografin as an alternative booster to sodium phosphate in colon capsule endoscopy: safety and efficacy pilot study. Endosc Int Open 2015; 3: E659-E661
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Boal Carvalho P, Rosa B, Dias de Castro F. et al. PillCam COLON 2 in Crohn's disease: A new concept of pan-enteric mucosal healing assessment. World J Gastroenterol 2015; 21: 7233-7241
    CrossrefPubMedSearch in Google Scholar
  • 26 Romero-Vazquez J, Caunedo-Alvarez A, Belda-Cuesta A. et al. Extracolonic findings with the PillCam Colon: is panendoscopy with capsule endoscopy closer?. Endosc Int Open 2016; 4: E1045-E1051
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 Ota Y, Yamada A, Kobayashi Y. et al. Diagnostic capability of colon capsule endoscopy for advanced colorectal cancer: A pilot study. Dig Endosc 2017; 29: 695-701
    CrossrefPubMedSearch in Google Scholar
  • 28 Zhou J, Tang X, Wang J. et al. Feasibility of a novel low-volume and sodium phosphate-free bowel preparation regimen for colon capsule endoscopy. Exp Ther Med 2017; 14: 1739-1743
    CrossrefPubMedSearch in Google Scholar
  • 29 Nogales O, Garcia-Lledo J, Lujan M. et al. Therapeutic impact of colon capsule endoscopy with PillCam COLON 2 after incomplete standard colonoscopy: a Spanish multicenter study. Rev Esp Enferm Dig 2017; 109: 322-327
    PubMedSearch in Google Scholar
  • 30 Igawa A, Oka S, Tanaka S. et al. Evaluation for the clinical efficacy of colon capsule endoscopy in the detection of laterally spreading tumors. Digestion 2017; 95: 43-48
    CrossrefPubMedSearch in Google Scholar
  • 31 Sato J, Nakamura M, Watanabe O. et al. Prospective study of factors important to achieve observation of the entire colon on colon capsule endoscopy. Therap Adv Gastroenterol 2017; 10: 20-31
    CrossrefPubMedSearch in Google Scholar
  • 32 Pioche M, Ganne C, Gincul R. et al. Colon capsule versus computed tomography colonography for colorectal cancer screening in patients with positive fecal occult blood test who refuse colonoscopy: a randomized trial. Endoscopy 2018; 50: 761-769
    Thieme ConnectPubMedSearch in Google Scholar
  • 33 Takano R, Osawa S, Uotani T. et al. Evaluating mucosal healing using colon capsule endoscopy predicts outcome in patients with ulcerative colitis in clinical remission. World J Clin Cases 2018; 6: 952-960
    CrossrefPubMedSearch in Google Scholar
  • 34 Kobaek-Larsen M, Kroijer R, Dyrvig AK. et al. Back-to-back colon capsule endoscopy and optical colonoscopy in colorectal cancer screening individuals. Colorectal Dis 2018; 20: 479-485
    CrossrefPubMedSearch in Google Scholar
  • 35 Okabayashi S, Kobayashi T, Nakano M. et al. A simple 1-day colon capsule endoscopy procedure demonstrated to be a highly acceptable monitoring tool for ulcerative colitis. Inflamm Bowel Dis 2018; 24: 2404-2412
    CrossrefPubMedSearch in Google Scholar
  • 36 Eliakim R, Spada C, Lapidus A. et al. Evaluation of a new pan-enteric video capsule endoscopy system in patients with suspected or established inflammatory bowel disease – feasibility study. Endosc Int Open 2018; 6: E1235-E1246
    Thieme ConnectPubMedSearch in Google Scholar
  • 37 Parodi A, Vanbiervliet G, Hassan C. et al. Colon capsule endoscopy to screen for colorectal neoplasia in those with family histories of colorectal cancer. Gastrointest Endosc 2018; 87: 695-704
    CrossrefPubMedSearch in Google Scholar
  • 38 Baltes P, Bota M, Albert J. et al. PillCamColon2 after incomplete colonoscopy – A prospective multicenter study. World J Gastroenterol 2018; 24: 3556-3566
    CrossrefPubMedSearch in Google Scholar
  • 39 Voska M, Zavoral M, Grega T. et al. Accuracy of colon capsule endoscopy for colorectal neoplasia detection in individuals referred for a screening colonoscopy. Gastroenterol Res Pract 2019;
    CrossrefPubMedSearch in Google Scholar
  • 40 Yamada K, Nakamura M, Yamamura T. et al. Clinical factors associated with missing colorectal polyp on colon capsule endoscopy. Digestion 2020; 101: 316-322
    CrossrefPubMedSearch in Google Scholar
  • 41 Gonzalez-Suarez B, Pages M, Araujo IK. et al. Colon capsule endoscopy versus CT colonography in FIT-positive colorectal cancer screening subjects: a prospective randomised trial-the VICOCA study. BMC Med 2020; 18: 255
    CrossrefPubMedSearch in Google Scholar
  • 42 Otani I, Oka S, Tanaka S. et al. Diagnostic Yield of colon capsule endoscopy in detection of superficial colorectal lesions. Digestion 2020; 101: 262-269
    CrossrefPubMedSearch in Google Scholar
  • 43 Pecere S, Senore C, Hassan C. et al. Accuracy of colon capsule endoscopy for advanced neoplasia. Gastrointest Endosc 2020; 91: 406-414 e401
    CrossrefPubMedSearch in Google Scholar
  • 44 Utano K, Katsuki S, Matsuda T. et al. Colon capsule endoscopy versus ct colonography in patients with large non-polypoid tumours: a multicentre prospective comparative study (4CN Study). Digestion 2020; 101: 615-623
    CrossrefPubMedSearch in Google Scholar
  • 45 Eliakim R, Fireman Z, Gralnek IM. et al. Evaluation of the PillCam Colon capsule in the detection of colonic pathology: results of the first multicenter, prospective, comparative study. Endoscopy 2006; 38: 963-970
    Thieme ConnectPubMedSearch in Google Scholar
  • 46 Spada C, Riccioni ME, Hassan C. et al. PillCam colon capsule endoscopy: a prospective, randomized trial comparing two regimens of preparation. J Clin Gastroenterol 2011; 45: 119-124
    CrossrefPubMedSearch in Google Scholar
  • 47 Hartmann D, Keuchel M, Philipper M. et al. A pilot study evaluating a new low-volume colon cleansing procedure for capsule colonoscopy. Endoscopy 2012; 44: 482-486
    Thieme ConnectPubMedSearch in Google Scholar
  • 48 Kakugawa Y, Saito Y, Saito S. et al. New reduced volume preparation regimen in colon capsule endoscopy. World J Gastroenterol 2012; 18: 2092-2098
    CrossrefPubMedSearch in Google Scholar
  • 49 Arguelles-Arias F, San-Juan-Acosta M, Belda A. et al. Preparations for colon capsule endoscopy. Prospective and randomized comparative study between two preparations for colon capsule endoscopy: PEG 2 liters + ascorbic acid versus PEG 4 liters. Rev Esp Enferm Dig 2014; 106: 312-317
    PubMedSearch in Google Scholar
  • 50 Ramos L, Alarcon O, Adrian Z. et al. One-day versus two-day cleansing for colon capsule endoscopy: a prospective randomized pilot study. Gastroenterol Hepatol 2014; 37: 101-106
    CrossrefPubMedSearch in Google Scholar
  • 51 Brechmann T, Schmiegel W, Klute L. et al. Feasibility of a colon capsule overnight procedure followed by colonoscopy. Z Gastroenterol 2016; 54: 146-151
    Thieme ConnectPubMedSearch in Google Scholar
  • 52 Kastenberg D, Burch Jr. WC, Romeo DP. et al. Multicenter, randomized study to optimize bowel preparation for colon capsule endoscopy. World J Gastroenterol 2017; 23: 8615-8625
    CrossrefPubMedSearch in Google Scholar
  • 53 Alvarez-Urturi C, Fernandez-Esparrach G, Ibanez IA. et al. Accuracy of colon capsule endoscopy in detecting colorectal polyps in individuals with familial colorectal cancer: could we avoid colonoscopies?. Gastroenterol Res Pract 2017;
    CrossrefPubMedSearch in Google Scholar
  • 54 Buijs MM, Kobaek-Larsen M, Kaalby L. et al. Can coffee or chewing gum decrease transit times in Colon capsule endoscopy? A randomized controlled trial. BMC Gastroenterol 2018; 18: 95
    CrossrefPubMedSearch in Google Scholar
  • 55 Kroijer R, Dyrvig AK, Kobaek-Larsen M. et al. Booster medication to achieve capsule excretion in colon capsule endoscopy: a randomized controlled trial of three regimens. Endosc Int Open 2018; 6: E1363-E1368
    Thieme ConnectPubMedSearch in Google Scholar
  • 56 Ohmiya N, Hotta N, Mitsufuji S. et al. Multicenter feasibility study of bowel preparation with castor oil for colon capsule endoscopy. Dig Endosc 2019; 31: 164-172
    CrossrefPubMedSearch in Google Scholar
  • 57 Spada C, Hassan C, Galmiche JP. et al. Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2012; 44: 527-536
    Thieme ConnectPubMedSearch in Google Scholar
  • 58 Lieberman DA, Ghormley J, Flora K. Effect of oral sodium phosphate colon preparation on serum electrolytes in patients with normal serum creatinine. Gastrointest Endosc 1996; 43: 467-469
    CrossrefPubMedSearch in Google Scholar
  • 59 Hassan C, East J, Radaelli F. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019. Endoscopy 2019; 51: 775-794
    Thieme ConnectPubMedSearch in Google Scholar
  • 60 Rex DK, Vanner SJ. Colon cleansing before colonoscopy: does oral sodium phosphate solution still make sense?. Can J Gastroenterol 2009; 23: 210-214
    CrossrefPubMedSearch in Google Scholar
  • 61 Schreuders EH, Ruco A, Rabeneck L. et al. Colorectal cancer screening: a global overview of existing programmes. Gut 2015; 64: 1637-1649
    CrossrefPubMedSearch in Google Scholar
  • 62 Koulaouzidis A, Marlicz W, Wenzek H. et al. Returning to digestive endoscopy normality will be slow and must include novelty and telemedicine. Dig Liver Dis 2020; 52: 1099-1101
    CrossrefPubMedSearch in Google Scholar
  • 63 MacLeod C, Wilson P, Watson AJM. Colon capsule endoscopy: an innovative method for detecting colorectal pathology during the COVID-19 pandemic?. Colorectal Dis 2020; 22: 621-624
    CrossrefPubMedSearch in Google Scholar
  • 64 Buijs MM, Ramezani MH, Herp J. et al. Assessment of bowel cleansing quality in colon capsule endoscopy using machine learning: a pilot study. Endosc Int Open 2018; 6: E1044-E1050
    Thieme ConnectPubMedSearch in Google Scholar
  • 65 Blanes-Vidal V, Baatrup G, Nadimi ES. Addressing priority challenges in the detection and assessment of colorectal polyps from capsule endoscopy and colonoscopy in colorectal cancer screening using machine learning. Acta Oncol 2019; 58: S29-S36
    CrossrefPubMedSearch in Google Scholar
  • 66 Spada C, Hassan C, Costamagna G. Colon capsule endoscopy in colorectal cancer screening: a rude awakening from a beautiful dream?. Clin Gastroenterol Hepatol 2015; 13: 2302-2304
    CrossrefPubMedSearch in Google Scholar
  • 67 Spada C, Hassan C, Bellini D. et al. Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020. Endoscopy 2020;
    Thieme ConnectPubMedSearch in Google Scholar
  • 68 Cash BD, Fleisher MR, Fern S. et al. Multicentre, prospective, randomised study comparing the diagnostic yield of colon capsule endoscopy versus CT colonography in a screening population (the TOPAZ study). Gut 2020;
    CrossrefPubMedSearch in Google Scholar
  • 69 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
    Thieme ConnectPubMedSearch in Google Scholar
  • 70 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
    CrossrefPubMedSearch in Google Scholar
  • 71 Zhao S, Wang S, Pan P. et al. Magnitude, risk factors, and factors associated with adenoma miss rate of tandem colonoscopy: a systematic review and meta-analysis. Gastroenterology 2019; 156: 1661-1674 e1611
    CrossrefPubMedSearch in Google Scholar
  • 72 Kaalby L, Deding U, Kobaek-Larsen M. et al. Colon capsule endoscopy in colorectal cancer screening: a randomised controlled trial. BMJ Open Gastroenterol 2020; 7
    CrossrefPubMedSearch in Google Scholar
  • 73 Singhal S, Nigar S, Paleti V. et al. Bowel preparation regimens for colon capsule endoscopy: a review. Therap Adv Gastroenterol 2014; 7: 115-122
    CrossrefPubMedSearch in Google Scholar
  • 74 Adler SN, Hassan C, Metzger Y. et al. Second-generation colon capsule endoscopy is feasible in the out-of-clinic setting. Surg Endosc 2014; 28: 570-575
    CrossrefPubMedSearch in Google Scholar