Endoscopy 2018; 50(04): S18
DOI: 10.1055/s-0038-1637078
ESGE Days 2018 oral presentations
20.04.2018 – Small bowel
Georg Thieme Verlag KG Stuttgart · New York

DOES POLYETHYLENE GLYCOL CLEANSING PURGE IMPROVE VIDEO CAPSULE ENDOSCOPY DIAGNOSTIC YIELD IN OBSCURE GASTROINTESTINAL BLEEDING?

F Cholet
1   Centre Hospitalo-Universitaire de Brest, Brest, France
,
G Rahmi
2   CHU Georges Pompidou (HEGP), Paris, France
,
M Gaudric
3   CHU Cochin (APHP), Paris, France
,
J Filippi
4   CHU Nice, Nice, France
,
C Duburque
5   Universite Catholique, Lille, France
,
S Bramli
6   CH Duffaut, Avignon, French Guiana
,
V Quentin
7   CH, Saint-Brieuc, France
,
Z Alavi
8   Inserm CIC 1412 EA3878, Brest, France
,
A Dion
8   Inserm CIC 1412 EA3878, Brest, France
,
JC Saurin
9   CHU Edouard Herriot, Lyon, France
,
M Robaszkiewicz
10   CHU La Cavale Blanche, Brest, France
,
C Cellier
2   CHU Georges Pompidou (HEGP), Paris, France
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Small-bowel cleansing is required prior video capsule endoscopy (VCE). Nevertheless, there is no consensus on the type, volume and regimen of cleansing purge. Moreover, guidelines recommend polyethylene glycol (PEG) but are 1C GRADE (low quality evidence). Randomized, multicenter, prospective studies are still required. Our study aimed to compare the frequency of diagnosis of at least one lesion: high bleeding potential (P2) or intermediate bleeding potential (P1) of small bowel in patients with gastrointestinal bleeding (OGIB) undergoing VCE using different cleansing regimens.

Methods:

Patients with OGIB undergoing VCE were consecutively randomized to the following groups: Prep-1 standard purge (control), Prep-2 standard + 500 mL PEG purge 30 minutes after VCE intake, Prep-3 standard + 2 L PEG the night before + 500 mL PEG 30 minutes after VCE intake.

Results:

834 patients were included (277 controls, 284 Prep-2 and 273 Prep-3) with a mean hemoglobin level of 8.2 g/dL and 32.3% presented with overt gastrointestinal bleeding. 790 patients met the criteria for primary objective. No significant difference in frequency of P1 or P2 lesion was observed between preparation groups and control: 40.22% for Prep-1, 38.46% for Prep-2 and 40.54% in the control group (Bonferroni-corrected p-value = 1.0). PEG purge moderately improves the small bowel cleanliness score (p =< 0.001, < 0.001). It increases in average by 15 minutes the gastric transit time (p =< 0.002, < 0.008) and reduces by 50 minutes the small bowel transit time (p =< 0.001, < 0.001). Despite the differences in transit times, PEG had no impact on VCE procedure completeness (Prep-1 = 89.6%, Prep-2 = 92.3%, Prep-3 = 91.2%).

Conclusions:

PEG did not improve the diagnostic yield of VCE in this large randomized study, eventhough the small bowel cleanliness score is moderately improved. A standard regimen without PEG seems to be sufficient for VCE exploration in OGIB.