Comparison of two schemes of small bowel preparation for capsule endoscopy with polyethylene glycol: a prospective, randomized single-blind study.

OBJECTIVE: Small bowel preparation for capsule endoscopy remains controversial. This study was conducted to compare the efficacy of 2 and 4 l of polyethylene glycol. METHODS: One hundred and one patients (group A) received 2 l and 100 (group B) received 4 l in a prospective, randomized single-blind trial. To objectively evaluate enteric preparation, a cleansing coefficient was calculated for each patient. RESULTS: The two groups were found comparable regarding age, sex, body mass index, and reason for referral. In 82 patients of group A and in 76 of group B, examination of small bowel was completed (P =0.40). Gastric emptying time and small bowel transit time were found comparable in both groups. Cleansing coefficients, for small bowel as a whole or for proximal or distal separately, were similar among the two groups. However, the cleansing coefficient of the proximal bowel was significantly higher than that of the distal, independently of preparation (group A: P < 0.001, group B: P< 0.001). Small bowel preparation was related only with the age of the patients and gastric emptying time; the younger the patient or the shorter the gastric emptying time, the higher the cleansing coefficient. Pathological findings were found in 43 (42.6%) patients of group A and in 37 (37.0%) patients of group B (P =0.42). A final positive diagnosis was established in 33 (32.7%) patients of group A and in 29 (29.0%) of group B (P = 0.57). CONCLUSION: The two schemes were equal regarding enteric cleansing and completion of the procedure. Therefore, 2 l seems to be an adequate preparation for capsule endoscopy.

Endoscopic variceal ligation vs. propranolol for prevention of first variceal bleeding: a randomized controlled trial.

OBJECTIVES: Data in the literature regarding the role of endoscopic variceal ligation for the prevention of first variceal bleeding in cirrhotic patients are controversial. To further explore this issue we have compared ligation and propranolol treatment in a prospective randomized study. METHODS: Sixty patients with cirrhosis and oesophageal varices with no history but at high risk of bleeding were randomized to ligation treatment (30 patients) or propranolol (30 patients). Patients were followed for approximately 27.5 months. RESULTS: Variceal obliteration was achieved in 28 patients (93.3%) after 3+/-1 sessions. The mean daily dose of propranolol was 60.3+/-13.3 mg. Two patients (6.7%) in the ligation group and nine patients (30%) in the propranolol group developed variceal bleeding (P = 0.043). The actuarial risks of variceal bleeding at 2 years were 6.7% and 25%, respectively. On multivariate analysis, propranolol treatment and grade III varices turned out to be predictive factors for the risk of variceal bleeding. Mortality was not different between the two groups. There were no serious complications due to ligation. Propranolol treatment was discontinued in four patients because of side effects. CONCLUSIONS: Variceal ligation is a safe and more effective method than propranolol treatment for the prevention of first variceal bleeding in cirrhotic patients with high-risk varices.