Optimal use of polyethylene glycol for preparation of small bowel video capsule endoscopy: a network meta-analysis

Abstract

Objective: Standardized strategy of bowel preparation before video capsule endoscopy (VCE) remains controversial. This study aimed to assess the ideal dose of PEG, based on small bowel visualization quality (SBVQ), diagnostic yield (DY), and complete rate (CR) of VCE using a network meta-analysis (NMA) of randomized controlled trials (RCTs).

Methods: This NMA included RCTs comparing any of the following bowel preparation interventions for VCE: fasting overnight (“Fast”), 1 liter PEG (“PEG 1L”), 2-liter PEG (“PEG 2L”), or 4-liter PEG (“PEG 4L”). The authors searched papers in PubMed, Cochrane Library, and Embase as of June 2016. The cumulative ranking (SUCRA) probabilities to rank different doses of PEG and Fast were used.

Results: The search engine provided 102 studies. Nine RCTs including 982 patients were incorporated into this analysis. All studies showed low risk of bias of blinding. SUCRA provided an initial ranking among these strategies, in which PEG 2 L showed the best score in SBVQ (PEG 2 L, 89.4%; PEG 1 L, 62.5%; PEG 4 L, 44.0%; Fast, 4.1%) and DY (PEG 2 L, 74.6%; PEG 1 L 28.1%; PEG 4 L 65.9%; Fast 31.4%) of VCE. No significant difference was shown in the analysis of CR.

Conclusions: This study recommends PEG 2 L as the ideal dose, which may improve the SBVQ of VCE and, therefore, diagnostic accuracy. Multi-center randomized controlled trials are required to verify these findings.

Keywords:

• Video capsule endoscopy (VCE)
• Bowel preparation
• Dose of polyethylene glycol (PEG)
• Small bowel visualization quality (SBVQ)
• Network meta-analysis (NMA)

Transparency

Declaration of funding

No funding sponsored this study.

Declaration of financial/other relationships

There were no financial relationships with a commercial entity producing healthcare related products and/or services relevant to this article. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgement

We thank all the researchers who have proved their data to this NMA and the professors who prove technical guidance in the data analysis.