Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Jul 5, 2021; 12(4): 79-89
Published online Jul 5, 2021. doi: 10.4292/wjgpt.v12.i4.79
Castor oil as booster for colon capsule endoscopy preparation reduction: A prospective pilot study and patient questionnaire
Kota Takashima, Yoriaki Komeda, Toshiharu Sakurai, Sho Masaki, Tomoyuki Nagai, Shigenaga Matsui, Satoru Hagiwara, Mamoru Takenaka, Naoshi Nishida, Hiroshi Kashida, Konosuke Nakaji, Tomohiro Watanabe, Masatoshi Kudo
Kota Takashima, Yoriaki Komeda, Toshiharu Sakurai, Sho Masaki, Tomoyuki Nagai, Shigenaga Matsui, Satoru Hagiwara, Mamoru Takenaka, Naoshi Nishida, Hiroshi Kashida, Tomohiro Watanabe, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
Konosuke Nakaji, Division of Gastroenterology, Department of Internal Medicine, Endoscopy Center, Aishinkai Nakae Hospital, Wakayama-Shi 640-8461, Japan
Author contributions: Komeda Y contributed conceptualization, methodology, and formal analysis; Takashima K and Komeda Y contributed investigation, and wrote original draft; Watanabe T and Kudo M reviewed and edited the manuscript; Sakurai T, Masaki S, Nagai T, Matsui S, Takenaka M, Nishida N, Kashida H, and Nakaji K contributed data collection; Hagiwara S contributed statistical analysis; all authors have read and agreed to the published version of the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of Kindai University Hospital (29-087) and the procedures were in accordance with the Declaration of Helsinki.
Clinical trial registration statement: The clinical trial is registered with University Hospital Medical Information Network, using identifier UMIN000028694. Details can be found at https://upload.umin.ac.jp/cgi-openbin/ctr_e/ctr_view.cgi?recptno=R000032809.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yoriaki Komeda, MD, PhD, Senior Lecturer, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osaka 589-8511, Japan. y-komme@mvb.biglobe.ac.jp
Received: February 2, 2021
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
Abstract
BACKGROUND

Preparation for colon capsule endoscopy (CCE) requires a large liquid laxative volume for capsule excretion, which compromises the procedure's tolerability.

AIM

To assess the safety and utility of castor oil-boosted bowel preparation.

METHODS

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.

RESULTS

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.

CONCLUSION

The castor oil-based regimen could reduce bowel preparation dose and improve CCE tolerability.

Keywords: Bowel preparation regimen, Castor oil, Colon capsule endoscopy, Colonoscopy, Colorectal diseases, Prospective study

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.