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Abstract: Background: capsule endoscopy is a novel non-invasive method for visualization of the entire small bowel. The diagnostic yield of capsule endoscopy depends on the quality of visualization of the small bowel mucosa and its complete passage through the small bowel. To date, there is no standardized protocol for bowel preparation before capsule endoscopy. The addition of simethicone in the bowel preparation for the purpose of reducing air bubbles in the intestinal lumen had only been studied by a few investigators. Methods: Sixty-four participants were randomly divided into two groups to receive a bowel preparation of polyethylene glycol (PEG) solution (Group 1) and both PEG solution and simethicone (Group 2). The PEG solution and simethicone were taken the night before and 20 min prior to capsule endoscopy, respectively. Frames taken in the small intestine were examined and scored for luminal bubbles by two professional capsule endoscopists. Gastric emptying time and small bowel transit time were also recorded. Results: simethicone significantly reduced luminal bubbles both in the proximal and distal small intestines. The mean time proportions with slight bubbles in the proximal and distal intestines in Group 2 were 97.1% and 99.0%, respectively, compared with 67.2% (P<0.001) and 68.8% (P<0.001) in Group 1. simethicone had no effect on mean gastric emptying time, 32.08 min in Group 2 compared with 30.88 min in Group 1 (P=0.868), but it did increase mean small intestinal transit time from 227.28 to 281.84 min (P=0.003). Conclusion: bowel preparation with both PEG and simethicone significantly reduced bubbles in the intestinal lumen and improved the visualization of the small bowel by capsule endoscopy without any side effects observed.

[1] Albert, J., Göbel, C.M., Lesske, J., Lotterer, E., Nietsch, H., Fleig, W.E., 2004. Simethicone for small bowel preparation for capsule endoscopy: a systematic, single-blinded, controlled study. Gastrointestinal Endoscopy, 59(4): 487-491.

[2] Ben-Soussan, E., Savoye, G., Antonietti, M., Ramirez, S., Ducrotté, P., Lerebours, E., 2005. Is a 2-liter PEG preparation useful before capsule endoscopy? Journal of Clinical Gastroenterology, 39(5):381-384.

[3] Costamagna, G., Shah, S.K., Riccioni, M.E., Foschia, F., Mutignani, M., Perri, V., Vecchioli, A., Brizi, M.G., Picciocchi, A., Marano, P., 2002. A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology, 123(4):999-1005.

[4] Dai, N., Gubler, C., Hengstler, P., Meyenberger, C., Bauerfeind, P., 2005. Improved capsule endoscopy after bowel preparation. Gastrointestinal Endoscopy, 61(1):28-31.

[5] Ell, C., Remke, S., May, A., Helou, L., Henrich, R., Mayer, G., 2002. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy, 34(9): 685-689.

[6] Fang, Y.H., Zhang, B.L., Wu, J.G., Chen, C.X., 2007. A primary intestinal lymphangiectasia patient diagnosed by capsule endoscopy and confirmed at surgery: a case report. World Journal of Gastroenterology, 13(15):2263.

[7] Fireman, Z., Mahajna, E., Broide, E., Shapiro, M., Fich, L., Sternberg, A., Kopelman, Y., Scapa, E., 2003. Diagnosing small bowel Crohn’s disease with wireless capsule endoscopy. British Society of Gastroenterology, 52: 390-392.

[8] Ge, Z.Z., Chen, H.Y., Gao, Y.J., Hu, Y.B., Xiao, S.D., 2006. The role of simeticone in small-bowel preparation for capsule endoscopy. Endoscopy, 38(8):836-840.

[9] Ginsberg, G.G., Barkun, A.N., Bosco, J.J., Isenberg, G.A., Nguyen, C.C., Petersen, B.T., Silverman, W.B., Slivka, A., Taitelbaum, G., 2002. Wireless capsule endoscopy. Gastrointestinal Endoscopy, 56(5):621-624.

[10] Hahne, M., Adamek, H.E., Schilling, D., Riemann, J.F., 2002. Wireless capsule endoscopy in a patient with obscure occult bleeding. Endoscopy, 34(7):588-590.

[11] Hammer, H.F., Santa Ana, C.A., Schiller, L.R., Fordtran, J.S., 1989. Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. Journal of Clinical Investigation, 84(4):1056-1062.

[12] Iddan, G., Meron, G., Glukhovsky, A., Swain, P., 2000. Wireless capsule endoscopy. Nature, 405(6785):417.

[13] Kark, W., Krebs-Richter, H., Hotz, J., 1995. Improving the effect of orthograde colonic lavage with golytely solution by adding dimethicone. Zeitschrift Gastroenterologie, 33(1):20-23.

[14] Keuchel, M., Hagenmuller, F., 2005. Small bowel endoscopy. Endoscopy, 37(2):122-132.

[15] Liangpunsakul, S., Chadalawada, V., Rex, D.K., Maglinte, D., Lappas, J., 2003. Wireless capsule endoscopy detects small bowel ulcers in patients with normal results from state of the art enteroclysis. American Journal of Gastroenterology, 98(6):1295-1298.

[16] Mylonaki, M., Fritscher-Ravens, A., Swain, P., 2003. Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding. British Society of Gastroenterology, 52:1122-1126.

[17] Shiotani, A., Opekun, A.R., Graham, D.Y., 2007. Visualization of the small intestine using capsule endoscopy in healthy subjects. Digestive Diseases and Sciences, 52(4): 1019-1025.

[18] van Tuyl, S.A., den Ouden, H., Stolk, M.F., Kuipers, E.J., 2007. Optimal preparation for video capsule endoscopy: a prospective, randomized, single-blind study. Endoscopy, 39(12):1037-1040.

[19] Viazis, N., Sgouros, S., Papaxoinis, K., Vlachogiannakos, J., Bergele, C., Sklavos, P., Panani, A., Avgerinos, A., 2004. Bowel preparation increases the diagnostic yield of capsule endoscopy: a prospective, randomized, controlled study. Gastrointestinal Endoscopy, 60(4):534-538.

[20] Wei, W., Ge, Z.Z., Lu, H., Gao, Y.J., Hu, Y.B., Xiao, S.D., 2008. Purgative bowel cleansing combined with simethicone improves capsule endoscopy imaging. The American Journal of Gastroenterology, 103(1):77-82.