What Is the Optimal Timing of Bowel Preparation for Video Capsule Endoscopy?

preparation prior to video capsule endoscopy (VCE) is as essential as bowel preparation prior to colonoscopy, since several factors, such as food material, air bubbles in the small bowel and delayed gastric and small bowel transit time (SBTT) influence the small bowel visualization quality (SBVQ), diagnostic yield (DY), and completion rate (CR). The 2009 Euro-pean Society of Gastrointestinal Endoscopy guidelines advise that purgative bowel preparations enhance the DY of a small bowel examination using VCE and do not affect the VCE CR (category of evidence 2a; grade of recommendation B). 1 According to the 2013 Korean guidelines from the Korean Gut Image Study Group, 2 bowel preparation with polyethyl-ene glycol (PEG) solution enhances SBVQ and DY, but has no effect on cecal CR. Bowel preparation with 2 L of PEG solution is similar to that with 4 L of PEG in terms of the SBVQ, DY, and CR of VCE. Bowel preparation with fasting or PEG solution combined with simethicone enhances the SBVQ, but does not affect the CR of VCE. Bowel preparation with proki-netics does not enhance the SBVQ, DY, or CR of VCE. A 2 L PEG-based purge, administered the day before the procedure, is the most widely practiced preparation regimen. 3 To date, there is no consensus regarding the optimal timing of bowel preparation for VCE. 4 Black et al. 5 conducted a single-center randomized controlled trial evaluating preparation for VCE. Thirty-four patients were randomized prospectively into two equal groups according to the timing of intestinal lavage (2 L of PEG). Group A had the intestinal lavage over 2 hours, beginning 14 hours before the scheduled VCE, and group B began ingestion 4 hours prior to the study. The results regarding mucosal abnormalities (77% vs. 82%, p=not significant [NS]) and DY (47% vs. 53%, p=NS) were similar for both groups. There was no significant association between the quality and timing of small bowel preparation. The day before intestinal lavage was similar to same-day preparation with respect to overall preparation quality , CR, SBTT, frequency of identified mucosal abnormalities, and overall DY. To the best of our knowledge, this is the first study to consider the timing of bowel preparation for VCE and is the first to assess the optimal 'timing' for initiating intestinal lavage in VCE. As mentioned, timing of purgative administration may be a critical factor for visualization and VCE CRs. Most purga-tive studies have administered …