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Oral Sodium Phosphate, Fasting Are Equal for Bowel Preparation Before Capsule Endoscopy for Obscure GI Bleeding NEW YORK -- June 18, 2008 -- Bowel preparation with oral sodium phosphate (NaP) for capsule endoscopy (CE) in patients with obscure gastrointestinal (GI) bleeding is no better at cleansing the small bowel than the standard method of preparation, which is an 8-hour fast before the procedure, according to a new study that appears in the June issue of Gastrointestinal Endoscopy. Prior to this study, there was limited consensus that preparations or prokinetics could improve the quality of small bowel cleanliness. Diagnostic results of CE may be reduced when visibility of the mucosa is impaired because of intestinal content or slow capsule progression. "The aim of our study was to compare bowel preparation with oral sodium phosphate versus none, without prokinetics, for capsule endoscopy examination of the small bowel in obscure GI bleeding," said study lead author Marie-George Lapalus, MD, Hopital Edouard Herriot, Lyon, France. A total of 129 patients with obscure GI bleeding were enrolled in this prospective, multicentre, controlled study between December 2004 and February 2006. The patients, 53 men and 76 women, with a median age of 56.9 years, were randomised into 2 groups. In group A, patients were instructed to consume only clear liquids during the evening before the procedure, followed by an 8-hour fast. In group B, patients were asked to drink NaP 45 mL with a glass of water the evening before and the morning of the procedure by using at least 2 L of clear liquid until midnight. Only a 3-hour fast was required in group B. After swallowing the capsule, the patients were not permitted to consume liquids (for 2 hours) or foods (for 4 hours), regardless of randomisation. Iron supplements and vegetal charcoal were stopped 8 days before CE examination to avoid black stool residue. No added prokinetic drug was used. Researchers, who were blinded to the randomisation, independently evaluated the CE images. Gastric emptying time, small bowel transit time, and whether or not the cecum was reached were recorded for each patient. Because a universally accepted scale for grading bowel cleanliness is lacking, researchers developed their own scale, assessing preparation at 5 different segments: duodenum, jejunum, middle small bowel, ileum, and distal ileum. Bowel cleanliness and visibility were evaluated by assessing the presence of bubbles, liquid, and the rate of visibility. Of the 129 patients enrolled, 127 were analysed because 2 patients were not able to swallow the capsule. No difference was observed for cleanliness and visibility -- the primary outcome variables -- between the 2 groups at any of the small bowel segments. Furthermore, no difference was found for gastric transit time, small bowel transit time, or likelihood of finding small bowel lesions. "We found that there was no difference observed for cleanliness and visibility between the group that was given oral sodium phosphate and the group that fasted. Therefore, our study concludes that oral sodium phosphate cannot be recommended for CE exploration in patients with obscure GI bleeding," said Dr. Lapalus. The authors concluded that despite some study limitations (eg, use of a nonstandardised scoring system, possibility that too few patients were enrolled), NaP before a CE in patients with GI bleeding cannot be recommended based on their results. They acknowledged that further large studies combining preparation and prokinetics with diagnostic yield as the primary endpoint are still necessary. SOURCE: American Society for Gastrointestinal Endoscopy E-mail this page to a friend or colleague! To print, use this version