Published online Jul 5, 2021. doi: 10.4292/wjgpt.v12.i4.79
Peer-review started: February 2, 2021
First decision: February 24, 2021
Revised: March 22, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: July 5, 2021
Preparation for colon capsule endoscopy (CCE) requires a large liquid laxative volume for capsule excretion, which compromises the procedure's tolerability.
To assess the safety and utility of castor oil-boosted bowel preparation.
This prospective cohort study including 20 patients (age range, 16-80 years; six men and 14 women) suspected of having colorectal disease was conducted at Kindai University Hospital from September 2017 to August 2019. All patients underwent CCE because of the following inclusion criteria: previous incomplete colonoscopy in other facility (n = 20), history of abdominal surgery (n = 7), or organ abnormalities such as multiple diverticulum (n = 4) and adhesion after surgery (n = 6). The exclusion criteria were as follows: Dysphagia, history of allergic reactions to the drugs used in this study (magnesium citrate, polyethylene glycol, metoclopramide, and castor oil), possibility of pregnancy, possibility of bowel obstruction or stenosis based on symptoms, or scheduled magnetic resonance imaging within 2 wk after CCE. The primary outcome was the capsule excretion rate within the battery life, as evaluated by the total large bowel observation rate, large bowel transit time, and bowel creasing level using a five-grade scale in different colorectal segments. The secondary outcomes were complications, colorectal lesion detection rates, and patients’ tolerability.
The castor oil-based regimen was implemented in 17 patients. Three patients cancelled CCE because they could tolerate castor oil, but not liquid laxatives. The capsule excretion rate within the battery life was 88% (15/17). The mean large bowel transit time was 236 min. Approximately 70% of patients had satisfactory colon cleansing levels. CCE detected colon polyps (14/17, 82%) and colonic diverticulum (4/12, 33%). The sensitivity, specificity, and diagnostic accuracy rates for detecting colorectal polyps (size ≥ 6 mm) were 76.9%, 75.0%, and 76.4%, respectively. The sensitivity, specificity, and diagnostic accuracy rates for detection of diverticulum were 100% each. Twelve patients (71%) rated CCE as more than “good”, confirming the new regimen’s tolerability. No serious adverse events occurred during this study.
The castor oil-based regimen could reduce bowel preparation dose and improve CCE tolerability.
Core Tip: Castor oil, a vegetable oil collected from castor oil plant seeds, is hydrolyzed into glycerin and retinoic acid in the small intestine, stimulating bowel movement in the small intestine. Among patients treated with castor oil as a booster, the rate of capsule excretion within battery life was 88%, whereas 70% of them had a more than “good” bowel cleansing level. The questionnaire of tolerability compared with previous colonoscopy showed that 71% of patients were satisfied with the new colon capsule endoscopy procedure. Sensitivity, specificity, and diagnostic accuracy of detecting colorectal polyps (size ≥ 6 mm) were 76.9%, 75.0%, and 76.4%, respectively.