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 revie...
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| Veröffentlicht in: | Digestive diseases and sciences 2023-12, Vol.68 (12), p.4418-4431 |
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| creator | Rosa, Bruno Donato, Helena Cúrdia Gonçalves, Tiago Sousa-Pinto, Bernardo Cotter, José |
| description | 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 |
| doi_str_mv | 10.1007/s10620-023-08133-7 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2877379849</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A772271430</galeid><sourcerecordid>A772271430</sourcerecordid><originalsourceid>FETCH-LOGICAL-c463t-d4be8f1ee003fccccd542663be4372eb9b3f108c2500e04db7cae18ed3a655053</originalsourceid><addsrcrecordid>eNp9kdFqFDEUhoNYcK19Aa8C3ngz9SSZSWavZF2qLVRa1OJlyGTOtCmzyZhkLfsIvnWzHaUoxeQiIXzfzyE_Ia8ZHDMA9S4xkBwq4KKClglRqWdkwRolKt7I9jlZAJPlzph8QV6mdAsAS8Xkgvz6fmMyPUs03yC9mLLbmJF-CHc40suIk4kmu-DpECJdmyltR6TrMAYfkg3Tjhrf00vjK-czpux8kf9gJ76fofd0Rb_uUsZNybL0C_50ePdgfsZsqlWRdsmlV-RgMGPCo9_nIbn6ePJtfVqdX3w6W6_OK1tLkau-7rAdGCKAGGxZfVNzKUWHtVAcu2UnBgat5Q0AQt13yhpkLfbCyKaBRhySt3PuFMOPbZlab1yyOI7GY9gmzVulhFq29bKgb_5Bb8M2lnn3VMHKpwN7pK7NiNr5IeRo7D5Ur5TiXLFaQKGOn6DK7nHjbPA4uPL-l8BnwcaQUsRBT7G0E3eagd6XrufSdSldP5SuVZHELKUC-2uMjxP_x7oHw2qu3Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2887710601</pqid></control><display><type>article</type><title>What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis</title><source>SpringerLink Journals - AutoHoldings</source><creator>Rosa, Bruno ; Donato, Helena ; Cúrdia Gonçalves, Tiago ; Sousa-Pinto, Bernardo ; Cotter, José</creator><creatorcontrib>Rosa, Bruno ; Donato, Helena ; Cúrdia Gonçalves, Tiago ; Sousa-Pinto, Bernardo ; Cotter, José</creatorcontrib><description>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 < 4L polyethylene glycol (PEG) as purgative [77.5% (95% C.I. 68.4–87.8%);
I
2
= 47.3%]. The highest CR were observed using routine prokinetics prior to capsule ingestion [84.4% (95% C.I. 79.9–89.2%);
I
2
= 89.8%], and sodium phosphate (NaP) as “booster” [86.2% (95% C.I. 82.3–90.2%);
I
2
= 86.8%]. In univariable models, adjunctive laxatives were associated with higher ACR [OR 1.81 (95% C.I. 1.13; 2.90);
p
= 0.014]. CR was higher with routine prokinetics [OR 1.86 (95% C.I. 1.13; 3.05);
p
= 0.015] and split-dose PEG purgative [OR 2.03 (95% C.I. 1.01; 4.09),
p
= 0.048].
Conclusions
Main quality outcomes (ACR, CR) remain suboptimal for CC and PCE. Despite considerable heterogeneity, our results support low-fibre diet, use of adjunctive sennosides, split dose < 4L PEG, and routine prokinetics, while NaP remains the most consistent option as
booster
.</description><identifier>ISSN: 0163-2116</identifier><identifier>EISSN: 1573-2568</identifier><identifier>DOI: 10.1007/s10620-023-08133-7</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Analysis ; Biochemistry ; Colonoscopy ; Endoscopy ; Gastroenterology ; Hepatology ; Laxatives ; Medicine ; Medicine & Public Health ; Meta-analysis ; Oncology ; Online databases ; Original Article ; Phosphates ; Polyethylene glycol ; Polyols ; Prokinetic agents ; Quality control ; Quality management ; Sennosides ; Systematic review ; Transplant Surgery</subject><ispartof>Digestive diseases and sciences, 2023-12, Vol.68 (12), p.4418-4431</ispartof><rights>The Author(s) 2023</rights><rights>COPYRIGHT 2023 Springer</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c463t-d4be8f1ee003fccccd542663be4372eb9b3f108c2500e04db7cae18ed3a655053</citedby><cites>FETCH-LOGICAL-c463t-d4be8f1ee003fccccd542663be4372eb9b3f108c2500e04db7cae18ed3a655053</cites><orcidid>0000-0003-2885-0720 ; 0000-0002-2921-0648 ; 0000-0001-5540-6452 ; 0000-0002-1277-3401 ; 0000-0002-1905-1268</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10620-023-08133-7$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10620-023-08133-7$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids></links><search><creatorcontrib>Rosa, Bruno</creatorcontrib><creatorcontrib>Donato, Helena</creatorcontrib><creatorcontrib>Cúrdia Gonçalves, Tiago</creatorcontrib><creatorcontrib>Sousa-Pinto, Bernardo</creatorcontrib><creatorcontrib>Cotter, José</creatorcontrib><title>What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis</title><title>Digestive diseases and sciences</title><addtitle>Dig Dis Sci</addtitle><description>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 < 4L polyethylene glycol (PEG) as purgative [77.5% (95% C.I. 68.4–87.8%);
I
2
= 47.3%]. The highest CR were observed using routine prokinetics prior to capsule ingestion [84.4% (95% C.I. 79.9–89.2%);
I
2
= 89.8%], and sodium phosphate (NaP) as “booster” [86.2% (95% C.I. 82.3–90.2%);
I
2
= 86.8%]. In univariable models, adjunctive laxatives were associated with higher ACR [OR 1.81 (95% C.I. 1.13; 2.90);
p
= 0.014]. CR was higher with routine prokinetics [OR 1.86 (95% C.I. 1.13; 3.05);
p
= 0.015] and split-dose PEG purgative [OR 2.03 (95% C.I. 1.01; 4.09),
p
= 0.048].
Conclusions
Main quality outcomes (ACR, CR) remain suboptimal for CC and PCE. Despite considerable heterogeneity, our results support low-fibre diet, use of adjunctive sennosides, split dose < 4L PEG, and routine prokinetics, while NaP remains the most consistent option as
booster
.</description><subject>Analysis</subject><subject>Biochemistry</subject><subject>Colonoscopy</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Laxatives</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Oncology</subject><subject>Online databases</subject><subject>Original Article</subject><subject>Phosphates</subject><subject>Polyethylene glycol</subject><subject>Polyols</subject><subject>Prokinetic agents</subject><subject>Quality control</subject><subject>Quality management</subject><subject>Sennosides</subject><subject>Systematic review</subject><subject>Transplant Surgery</subject><issn>0163-2116</issn><issn>1573-2568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kdFqFDEUhoNYcK19Aa8C3ngz9SSZSWavZF2qLVRa1OJlyGTOtCmzyZhkLfsIvnWzHaUoxeQiIXzfzyE_Ia8ZHDMA9S4xkBwq4KKClglRqWdkwRolKt7I9jlZAJPlzph8QV6mdAsAS8Xkgvz6fmMyPUs03yC9mLLbmJF-CHc40suIk4kmu-DpECJdmyltR6TrMAYfkg3Tjhrf00vjK-czpux8kf9gJ76fofd0Rb_uUsZNybL0C_50ePdgfsZsqlWRdsmlV-RgMGPCo9_nIbn6ePJtfVqdX3w6W6_OK1tLkau-7rAdGCKAGGxZfVNzKUWHtVAcu2UnBgat5Q0AQt13yhpkLfbCyKaBRhySt3PuFMOPbZlab1yyOI7GY9gmzVulhFq29bKgb_5Bb8M2lnn3VMHKpwN7pK7NiNr5IeRo7D5Ur5TiXLFaQKGOn6DK7nHjbPA4uPL-l8BnwcaQUsRBT7G0E3eagd6XrufSdSldP5SuVZHELKUC-2uMjxP_x7oHw2qu3Q</recordid><startdate>20231201</startdate><enddate>20231201</enddate><creator>Rosa, Bruno</creator><creator>Donato, Helena</creator><creator>Cúrdia Gonçalves, Tiago</creator><creator>Sousa-Pinto, Bernardo</creator><creator>Cotter, José</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2885-0720</orcidid><orcidid>https://orcid.org/0000-0002-2921-0648</orcidid><orcidid>https://orcid.org/0000-0001-5540-6452</orcidid><orcidid>https://orcid.org/0000-0002-1277-3401</orcidid><orcidid>https://orcid.org/0000-0002-1905-1268</orcidid></search><sort><creationdate>20231201</creationdate><title>What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis</title><author>Rosa, Bruno ; Donato, Helena ; Cúrdia Gonçalves, Tiago ; Sousa-Pinto, Bernardo ; Cotter, José</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c463t-d4be8f1ee003fccccd542663be4372eb9b3f108c2500e04db7cae18ed3a655053</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Analysis</topic><topic>Biochemistry</topic><topic>Colonoscopy</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Laxatives</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Oncology</topic><topic>Online databases</topic><topic>Original Article</topic><topic>Phosphates</topic><topic>Polyethylene glycol</topic><topic>Polyols</topic><topic>Prokinetic agents</topic><topic>Quality control</topic><topic>Quality management</topic><topic>Sennosides</topic><topic>Systematic review</topic><topic>Transplant Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rosa, Bruno</creatorcontrib><creatorcontrib>Donato, Helena</creatorcontrib><creatorcontrib>Cúrdia Gonçalves, Tiago</creatorcontrib><creatorcontrib>Sousa-Pinto, Bernardo</creatorcontrib><creatorcontrib>Cotter, José</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive diseases and sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rosa, Bruno</au><au>Donato, Helena</au><au>Cúrdia Gonçalves, Tiago</au><au>Sousa-Pinto, Bernardo</au><au>Cotter, José</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis</atitle><jtitle>Digestive diseases and sciences</jtitle><stitle>Dig Dis Sci</stitle><date>2023-12-01</date><risdate>2023</risdate><volume>68</volume><issue>12</issue><spage>4418</spage><epage>4431</epage><pages>4418-4431</pages><issn>0163-2116</issn><eissn>1573-2568</eissn><abstract>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 < 4L polyethylene glycol (PEG) as purgative [77.5% (95% C.I. 68.4–87.8%);
I
2
= 47.3%]. The highest CR were observed using routine prokinetics prior to capsule ingestion [84.4% (95% C.I. 79.9–89.2%);
I
2
= 89.8%], and sodium phosphate (NaP) as “booster” [86.2% (95% C.I. 82.3–90.2%);
I
2
= 86.8%]. In univariable models, adjunctive laxatives were associated with higher ACR [OR 1.81 (95% C.I. 1.13; 2.90);
p
= 0.014]. CR was higher with routine prokinetics [OR 1.86 (95% C.I. 1.13; 3.05);
p
= 0.015] and split-dose PEG purgative [OR 2.03 (95% C.I. 1.01; 4.09),
p
= 0.048].
Conclusions
Main quality outcomes (ACR, CR) remain suboptimal for CC and PCE. Despite considerable heterogeneity, our results support low-fibre diet, use of adjunctive sennosides, split dose < 4L PEG, and routine prokinetics, while NaP remains the most consistent option as
booster
.</abstract><cop>New York</cop><pub>Springer US</pub><doi>10.1007/s10620-023-08133-7</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0003-2885-0720</orcidid><orcidid>https://orcid.org/0000-0002-2921-0648</orcidid><orcidid>https://orcid.org/0000-0001-5540-6452</orcidid><orcidid>https://orcid.org/0000-0002-1277-3401</orcidid><orcidid>https://orcid.org/0000-0002-1905-1268</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0163-2116 |
| ispartof | Digestive diseases and sciences, 2023-12, Vol.68 (12), p.4418-4431 |
| issn | 0163-2116 1573-2568 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2877379849 |
| source | SpringerLink Journals - AutoHoldings |
| subjects | Analysis Biochemistry Colonoscopy Endoscopy Gastroenterology Hepatology Laxatives Medicine Medicine & Public Health Meta-analysis Oncology Online databases Original Article Phosphates Polyethylene glycol Polyols Prokinetic agents Quality control Quality management Sennosides Systematic review Transplant Surgery |
| title | What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis |
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