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An evaluation of a novel bowel preparation regimen and its effect on the utility of colon capsule endoscopy: a prospective cohort study with historical controls

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Abstract

Background

The aim of this study was to evaluate the efficacy of a novel bowel preparation and booster regimen for colon capsule endoscopy (CCE) using macrogol, phospho-soda and gastrografin, compared with a control regimen consisting of polyethylene glycol and sodium picosulfate.

Methods

This was a prospective cohort study using historical controls. Symptomatic patients undergoing CCE between 11/07/2021 and 21/12/2021 using the novel regimen were included. Symptomatic patients who underwent CCE in the ScotCap evaluation using the control regimen were used as historical controls. We measured the rate of complete test (visualisation of the whole colon and rectum), adequate bowel preparation, successful test (complete and adequate bowel preparation) and need for further test following CCE. The rate of adverse events was also collected.

Results

Patients undergoing CCE using the new and control regimen were 200 and 316, respectively. The median age, age range and proportion of female patients in the new and control regimen cohorts was 61 vs 60 years, 16–86 vs 20–83 years, and 60.5% vs 56.6%. The rate of complete test, adequate bowel reparation and successful test for the new and control regimen was 69% vs 72.2%, 86.6% vs 80.7% and 60.5% vs 65.8%. Comparing the new and control regimen, 39.5% vs 37.3% of patients required no test following CCE, 26% vs 32.6% required a colonoscopy, 31.5% vs 21.5% required a flexible sigmoidoscopy and 3% vs 2.9% required a computed tomography colonogram. No adverse events were reported using the new regimen compared to 2 (0.6%) in the control group.

Conclusions

The rate of adequate bowel preparation has improved following the introduction of a new regimen. However, further work is needed to increase the complete test rate. A significant proportion of patients continue to avoid colonoscopy following CCE.

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Data availability

The data sets generated during and analysed during the current study are not publicly available due to the clinical nature of the data but are available from the corresponding author on reasonable request.

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Funding

No funding was received by any author to carry out this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ, UK

    C. Macleod, R. Oliphant, C. Richards & A. J. M. Watson

Authors
  1. C. Macleod
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  2. R. Oliphant
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  3. C. Richards
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  4. A. J. M. Watson
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by CM. The first draft of the manuscript was written by CM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to C. Macleod.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The work was clinical evaluation; therefore, NHS Caldicott guardian approval was obtained to collect and report the data in this study.

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Appendix

Appendix

CCE procedure protocol (CCE, colon capsule endoscopy)

  1. 1.

    Patients agreeing to undergo CCE are screened by a nurse who reviews their electronic healthcare records.

  2. 2.

    A telephone consultation is carried out by a specialist nurse to explain the procedure in detail, confirm consent to continue with the procedure and arrange test date.

  3. 3.

    The bowel preparation and associated instructions are sent to the patient.

  4. 4.

    Support for completing the bowel preparation is provided via a telephone consultation by a nurse.

  5. 5.

    The patient attends their CCE appointment and the procedure is carried out by a trained specialist nurse.

  6. 6.

    Pre procedure checks are carried out to ensure the patient is safe to continue with the procedure and that the bowel preparation has been adequate.

  7. 7.

    The belt and recorder are fitted, then the capsule is swallowed by the patient.

  8. 8.

    The booster medication is provided to the patient with associated instructions.

  9. 9.

    The patient returns home to complete the procedure returning the belt and recorder the following day.

  10. 10.

    The CCE recording is reported using the RapidTM Reader software (Medtronic) by an NHS Scotland gastroenterologist trained in CCE reading.

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Macleod, C., Oliphant, R., Richards, C. et al. An evaluation of a novel bowel preparation regimen and its effect on the utility of colon capsule endoscopy: a prospective cohort study with historical controls. Tech Coloproctol 27, 665–672 (2023). https://doi.org/10.1007/s10151-022-02745-3

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  • DOI: https://doi.org/10.1007/s10151-022-02745-3

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