Ensure preparation and capsule endoscopy: a two-center prospective study.

Ensure preparation and capsule endoscopy: a two-center prospective study.
World J Gastroenterol. 2013 Feb 28;19(8):1264-70. .
Niv E, Ovadia B, Ron Y, Santo E, Mahajna E, Halpern Z, Fireman Z.
AIM: To compare small bowel (SB) cleanliness and capsule endoscopy (CE) image
quality following Ensure(®), polyethylene glycol (PEG) and standard preparations.

METHODS: A preparation protocol for CE that is both efficacious and acceptable to
patients remains elusive. Considering the physiological function of the SB as a
site for the digestion and absorption of food and not as a stool reservoir,
preparation consisting of a liquid, fiber-free formula ingested one day before a
CE study might have an advantage over other kinds of preparations.

We conducted a
prospective, blind-to-preparation, two-center study that compared four types of
preparations. The participants’ demographic and clinical data were collected.

Gastric and SB transit times were calculated. The presence of bile in the
duodenum was scored by a single, blinded-to-preparation gastroenterologist expert
in CE, as was cleanliness within the proximal, middle and distal part of the SB.
A four-point scale was used (grade 1 = no bile or residue, grade 4 ≥ 90% of lumen
full of bile or residual material).
RESULTS: The 198 consecutive patients who were referred to CE studies due to
routine medical reasons were divided into four groups. They all observed a 12-h
overnight fast before undergoing CE. Throughout the 24 h preceding the fast,
control group 1 (n = 45 patients) ate light unrestricted meals, control group 2
(n = 81) also ate light meals but free of fruits and vegetables, the PEG group (n
= 50) ate unrestricted light meals and ingested the PEG preparation, and the
Ensure group (n = 22) ingested only the Ensure formula. Preparation with Ensure
improved the visualization of duodenal mucosa (a score of 1.76) by decreasing the
bile content compared to preparation with PEG (a score of 2.9) (P = 0.053).
Overall, as expected, there was less residue and stool in the proximal part of
the SB than in the middle and distal parts in all groups. The total score of
cleanliness throughout the length of the SB showed some benefit for Ensure (a
score of 1.8) over control group 2 (a score of 2) (P = 0.06). The cleanliness
grading of the proximal and distal parts of the SB was similar in all four groups
(P = 0.6 for both). The cleanliness in the middle part of the SB in the PEG (a
score of 1.8) and Ensure groups (a score of 1.7) was equally better than that of
control group 2 (a score of 2.1) (P = 0.057 and P = 0.07, respectively). All 50
PEG patients had diarrhea as an anticipated side effect, compared with only one
patient in the Ensure group.
CONCLUSION: Preparation with Ensure, a liquid, fiber-free formula has advantages
over standard and PEG preparations, with significantly fewer side effects than