Simplified bowel preparation for small bowel capsule endoscopy (SBCE) in Crohn’s disease

Rouveyre R et al, Aliment Pharmacol Ther. 2026;63(1):57-69
A simplified bowel preparation with clear liquid diet and water ingestion resulted in comparable cleanliness and SBCE diagnostic yield while improving acceptability as compared to polyethylene glycol-based preparation in a randomized multicenter trial in Crohn’s disease patients. 

Background: Small bowel (SB) capsule endoscopy (SBCE) is a key tool in patients with Crohn's disease (CD). Optimal bowel preparation remains debated.

Aims: To compare the efficacy of a simplified preparation (clear liquid diet with 500 mL of water pre- and 1 L post-capsule ingestion) to a polyethylene glycol (PEG)-based preparation (24 h-residue-free diet with 2 L of PEG) in patients with established CD.

Methods: In this randomised, controlled, single-blind, superiority, multicentre trial, patients were assigned 1:1 to either the simplified preparation or the PEG-based preparation. Intestinal cleanliness (quantified by the KODA score and qualitatively evaluated), patient acceptability, diagnostic yield, capsule completion rate, and SB transit time (SBTT) were compared between groups.
bowel_capsule_endoscopy

Results: With 142 SBCE, we observed no difference in intestinal cleanliness. Patients' acceptability of preparation and SBCE procedure was significantly higher with the simplified preparation. Diagnostic yield was similar, as well as the capsule completion rate and SBTT. The area under the receiver operating characteristic curve of the Korea-Canada (KODA) score was 0.87 (95% CI: 0.84-0.90). Using a threshold of 2.25, the score allowed us to discriminate images with 'good' and 'fair or poor' cleanliness with accuracy, sensitivity, and specificity of 80%, 76%, and 84%, respectively.

Conclusions: A simplified preparation consisting of a clear liquid diet and water is a viable alternative to a PEG-based preparation prior to SBCE in patients with CD, offering comparable SB cleanliness and diagnostic outcomes while improving acceptability.

C. Le Berre, Institut des Maladies de L'appareil Digestif (IMAD), Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Nantes Université, CHU Nantes, Nantes, France, e-mail: [email protected]

DOI: 10.1111/apt.70417