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How does sodium phosphate combined with bisacodyl affect small intestine?

May 21, 2008

Capsule endoscopy is a well accepted tool for evaluation of small bowel pathologies (e.g., bleeding sources). However, it has some limitations due to restricted recording time and reduced visibility by air and residual material. Several forms of preparation (e.g., prokinetic drugs, laxatives and defoaming agents) have been tried to improve the quality of the examination. However, to date no standardized protocol has been recommended for bowel preparation for CE.

This study, described in a research article, is to be published on April 7, 2008 in the World Journal of Gastroenterology.

We examined the effect of a combination of a saline (sodium phosphate) and a stimulant laxative (bisacodyl, Prepacol(R), Guerbet GmbH, Sulzbach, Germany) as a preparation before CE. Sodium phosphate solution is poorly absorbable and impedes water absorption from the gut through the osmotic gradient. Bisacodyl changes the net absorption of sodium and water in the small bowel into a net secretion and accelerates small intestinal transit.

52 consecutive patients receiving capsule endoscopy were included. The patients were prospectively randomized into two groups. Group A fasted at least 8 h before the examination; group B received additional Prepacol(R). Capsule endoscopy films were evaluated by three independent, endoscopically experienced investigators who were blinded concerning the kind of preparation. The following parameters were assessed: total quality of the film, visibility of small bowel mucosa, velocity of the capsule and occurrence of foam, air and residual food. Every parameter was graded from 1 to 4, as excellent, good, limited and poor quality.

Preparation with Prepacol(R) accelerated small bowel transit time , but had no effect on the different parameters of CE quality.

In the view of the authors, the investigated combination of sodium phosphate and bisacodyl is an inappropriate preparation for CE. Because CE is an expensive and time consuming examination, an effective preparation is essential to minimize false results at the best possible rate. Further studies considering the patient's compliance, which might be reduced by the taste of the preparation, are necessary to identify sufficient preparation procedures.

World Journal of Gastroenterology