| Sumario: | Background: Colon capsule endoscopy (CCE) is a minimally invasive alternative to colonoscopy, but its diagnostic performance depends entirely on adequate mucosal cleansing (adequate cleansing rate, ACR) and complete colonic transit (completion rate, CR). These requirements impose stringent preparation demands. Existing systematic reviews (SRs) show substantial heterogeneity in recommendations. Objectives: To identify optimal CCE preparation strategies. Design: Umbrella review (overview of SRs). Methods: A comprehensive literature search was conducted through November 2025 for SRs and meta-analyses (MAs) assessing CCE bowel preparation regimens. Methodological quality was assessed using AMSTAR2, and primary study overlap was quantified using the Corrected Covered Area (CCA). Outcomes included ACR and CR, stratified by preparation components. Results: Fourteen SRs (11 MAs) encompassing 102 primary studies (moderate overlap, CCA 8.59%) were included. Pooled ACR (72.5%–76.8%) and CR (79.8%–83.0%) remained below colonoscopy benchmarks. In inflammatory bowel disease, ACR varied widely (49%–98.5%) with no superior regimen. In the general population, low-volume polyethylene glycol (PEG <4 L) yielded higher ACR (77.5%) than high-volume PEG (72.9%). Sodium phosphate (NaP) boosters outperformed PEG specifically for CR, with NaP + Gastrografin achieving the highest CR (93.1%). Castor oil improved excretion (OR 0.17 of incomplete CCE transit, 95% CI 0.09–0.32), and routine prokinetics improved CR compared with no use (OR 1.86, 95% CI 1.13–3.05). Low-fiber diets provided better cleansing than clear liquids (ACR 78.5% vs 70.0%). Conclusion: Current CCE bowel preparation regimens demonstrate variable performance relative to targets, with no single intervention demonstrating unequivocal superiority over others in pairwise comparisons. Evidence supports optimizing performance via low-volume PEG, NaP or Gastrografin-based boosters, routine prokinetics, and a low-fiber diet. A universal regimen is unlikely to suit all patients, highlighting the need for personalized protocols. Standardized cleansing scores and AI-assisted assessment are critical to improving reproducibility and cost-effectiveness. Plain language summary: Optimizing bowel preparation for colon capsule endoscopy Colon capsule endoscopy is a non-invasive procedure that uses a swallowable pill-shaped camera to examine the large intestine to detect conditions like cancer or inflammation. While it offers a comfortable alternative to traditional colonoscopy, its success depends entirely on the colon being perfectly clean. Unlike standard endoscopes, the capsule cannot wash away debris or suction organic fluids. If the bowel is not completely clean, the examination may miss relevant lesion. Currently, there is no universally accepted standard for the best preparation protocol. To address this issue, we analyzed 14 major systematic reviews, encompassing data from 102 primary studies, to identify the most effective strategies for bowel preparation. The findings of this study highlight several key improvements for current protocols. First, a strict clear-liquid diet is not mandatory; allowing patients to eat low-fiber foods the day before the procedure actually improves cleansing results while enhancing patient comfort. Second, patients do not need to consume very high volumes of laxatives. Lower-volume solutions (under 4 liters) proved to be highly effective and are generally better tolerated by patients. Finally, keeping the capsule moving is critical, in order to avoid early battery depletion before the device is excreted. The routine use of specific medications that stimulate bowel movement (prokinetics), alongside targeted booster agents, is essential to ensure the capsule travels through the entire colon. In conclusion, the optimization and tailoring of laxative preparations significantly reduces the rate of incomplete examinations. This minimizes the need for repeat procedures, ultimately making colon capsule endoscopy a more reliable and cost-effective diagnostic tool.
|
|---|