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P153 Small bowel cleansing does not improve quality of wireless capsule endoscopy

E. Langholz1, R. Wilkens*2, 3, 4, 5, H. Glerup4

1Gentofte Hospital, Department of Medical Gastroenterology, Copenhagen, Denmark, 2University of Calgary, Department of Radiology, Calgary, Canada, 3University of Calgary, Department of Medicine, Division of Gastroenterology, Calgary, Canada, 4Regional Hospital Silkeborg, University Research Clinic for Innovative Patient Pathways, Diagnostic Center, Division of Gastroenterology, Silkeborg, Denmark, 5Aarhus University Hospital, Department of Hepatology and Gastroenterology, Aarhus, Denmark

Background

Wireless capsule endoscopy (WCE) is the most important tool for investigating obscure gastrointestinal bleeding in the small bowel and is superior to cross sectional imaging in detecting early and subtle inflammation of the small intestine in Crohn's Disease (CD). [1] With increasing demand of early diagnosis, WCE becomes more important. However, a drawback is the limited visualization of the mucosa in patients with poor cleansing quality. The aim of our study was to determine the benefit of preparation with Picoprep prior to examination with WCE and evaluate two different Methods for cleansing quality.

Methods

This prospective cluster trial examined all patients from two Danish centres, who underwent WCE with PillCam SB based on either known or suspected small bowel CD or obscure bleeding from August 2013 to July 2014. Our local ethics committee waived the necessity of informed consent. Both Centres used the same instructions for preparation; the day before examination, normal breakfast and lunch was allowed until 2 pm, hereafter patients were instructed to go on a liquid diet. Only water was allowed the last two hours before the procedure. Site A, in addition to Site B, instructed patients to ingest one sachet of Picoprep powder, at 9 pm the day before examination, followed by 1.5 litres of liquid diet, as per standard of care at Site A. Patients were matched between centres based on indication, sex and age. Cleansing quality was assessed by two different Methods described by Park et al. 2010 [2] with a 3 grade subjective assessment every 5 minutes and Weyenberg et al. 2011 [3] with a computer assessment of cleansing using the colour bar in the capsule reading software. Mean overall score between groups were compared using students t-test.

Results

We enrolled 135 consecutive patients allowing matching of 92 patients with a mean age of 45 years (16-83), 67 % women. CD was the indication in 69.6 %. Both scoring systems correlated well (rho = 0.80). Using both scoring systems, cleansing quality decreased significantly throughout the small bowel when comparing each third individually, p < 0.01. There were no overall difference in quality between groups.

Conclusion

Small bowel cleansing prior to WCE does not improve mucosal visualization of the small bowel in patients with suspected CD or obscure bleeding.

References:

[1] Mustafa BF, Samaan M, Langmead L, Khasraw M, (2013), Small bowel video capsule endoscopy: an overview, Expert review of gastroenterology & hepatology, 323-329

[2] Park SC, Keum B, Hyun JJ et al., (2010), A novel cleansing score system for capsule endoscopy, World Journal of Gastroenterology, 875-880

[3] Van Weynberg SJB, De Leest HTJI, Mulder CJJ, (2011), Description of a novel grading system to assess the quality of bowel preparation in video capsule endoscopy., Endoscopy, 406-411