Gastrografin as an alternative booster to sodium phosphate in colon capsule endoscopy: safety and efficacy pilot study* Authors

Sodium phosphate (NaP) is a key component of the standard bowel preparation regimen for colon capsule endoscopy (CCE, PillCom® COLON2 Capsule Endoscopy: Medtronic, Minneapolis, MN, USA), particularly to cause excretion of the capsule endoscope while the battery is still functioning. Previous reports have demonstrated that other laxatives including polyethylene glycol and magnesium citrate were not effective for excreting the capsule endoscope [1–3]. However, the use of NaP is limited due to the possibility of causing severe adverse events, e.g. acute phosphate nephropathy, acute renal failure, hypertension, or mineral imbalance [4,5]. The U.S.Food and Drug Administration issued a warning to restrict its purchase without a prescription in 2008. In Japan, administration of NaP for hypertensive patients 64 years or older has been contraindicated since February 2012.Therefore, an alternative to NaP is needed to perform CCE safely with a high completion rate. According to the latest report investigating the performance of CCE comparedwith CT colonography [6], Gastrografin (thewater-soluble iodinated radiopaque oral contrast medium) was first used for the CCE regimen, because Gastrografin is generally used as part of the CT colonography regimen for “fecal tagging” [7]. In our experience, a CCE regimen using Gastrografin without NaP, achieved a very high capsule excretion rate. The gastrointestinal transit time as well as the colon transit time with this bowel preparation regimen were comparable to that of CCE regimens using a NaP booster. In this paper, we report the results of a pilot study using Gastrografin as a booster in the bowel preparation regimen for CCE.