What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis

Background The rate of adequate cleansing (ACR) and complete examinations (CR) are key quality indicators in capsule colonoscopy (CC) and pan-intestinal capsule endoscopy (PCE). Aims To evaluate the efficacy of bowel preparation protocols regarding ACR and CR. Methods We conducted a systematic review and meta-analysis, search terms regarding colon capsule preparation, publication date from 2006/01, and date of search 2021/12, in six bibliographic databases. Multiple steps of the cleansing protocol were assessed: diet, adjunctive laxatives, purgative solution, use of prokinetic agents, and “booster”. The meta-analytical frequency of ACR and CR was estimated, and subgroup analyses performed. Strategies associated with higher ACR and CR were explored using meta-analytical univariable and multivariable regression models. Results Twenty-six observational studies and five RCTs included ( n = 4072 patients). The pooled rate of ACR was 72.5% (95% C.I. 67.8–77.5%; I 2 = 92.4%), and the pooled rate of CR was 83.0% (95% C.I. 78.7–87.7%; I 2 = 96.5%). The highest ACR were obtained using a low-fibre diet [78.5% (95% C.I. 72.0–85.6%); I 2 = 57.0%], adjunctive laxatives [74.7% (95% C.I. 69.8–80.1%); I 2 = 85.3%], and split dose