In patients with obscure GI bleeding undergoing exploration of the small bowel by capsule endoscopy, image quality is not improved by bowel preparation with oral sodium phosphate (NaP) rather than fasting, results of a study published in the June issue of Gastrointestinal Endoscopy indicate.

Capsule endoscopy (CE) was approved by the US Food and Drug Administration in 2001 for diagnosing disorders of the small intestine in adults. "Several studies have reported that CE has a higher diagnostic yield (55 per cent - 68 per cent) than push enteroscopy," Dr. Marie-George Lapalus, of Hopital Edouard Herriot, Lyon, France, and colleagues write. "However, the diagnostic yield may be reduced when visibility of the mucosa is impaired because of the intestinal content or slow capsule progression."

In a multicenter, randomized study, the researchers assigned 129 patients with a diagnosis of obscure GI bleeding to one of two groups: in group A, capsule endoscopy was performed after an eight-hour fasting period; in group B, patients drank two 45-mL doses of NaP before swallowing the capsule. The authors assessed the quality of the images at five different locations of the small bowel.

There were no differences between the groups for cleanliness and visibility at any of the small-bowel locations examined, the investigators report. No differences were observed between group A and group B for gastric emptying time or small-bowel transit time.

Lesions of the small bowel were found in 35.9 per cent of patients in group A and 42.8 per cent of those in group B.

"In conclusion, from the present study, despite a significant number of limitations, the use of small-bowel preparation with oral NaP before a CE in patients with GI bleeding cannot be recommended," Dr. Lapalus and colleagues state.

Gastrointest Endosc 2008;67:1091-1096