O9 Are bowel purgatives useful in small bowel capsule endoscopy? A randomised controlled trial of two different approaches
Bibliographic record
Abstract
Introduction Studies evaluating the value of purgative bowel preparation before small bowel capsule endoscopy have shown conflicting results. In this dual-centre, blinded, randomised controlled trial, we compared the effectiveness and tolerability of two polyethylene glycerol (PEG) purgative strategies against clear fluids only. Methods Adult patients with suspected small bowel pathology from Sheffield (UK) and Ontario (Canada) were randomised into 3 groups: a split dose PEG (Group A: 1L at 7pm day -1 and 1L at 6am day 0), a single dose PEG (Group B: 2L at 6 am Day 0) or clear fluids only (Group C). Cleanliness was assessed overall and in small bowel quartiles using a physician-assessed overall assessment of adequacy (OAA), a quantitative index (QI), and a computed assessment of cleanliness (CAC). Patients completed a questionnaire on the clinical tolerance and acceptance of the different strategies. Results A total of 269 patients (median age 50 years, 61.7% female) completed the study. The OAA was greater in group A and group B compared with group C (86%, 90%, and 71%, respectively; p=0.02). The QI of small bowel cleansing was higher in group A compared with group C (p=0.01) but was similar between groups B and C (P=0.12). The differences in OAA and QI between groups were only significant in the fourth quartile. There was no difference in the CAC between the three groups (p=0.95). Patients in group C reported better tolerability compared with groups A and B (76% vs 33.3% vs 44%; p<0.0001) and were more willing to undergo the procedure again if needed (97.4% vs 77.2 vs 82%; p<0.0001). There were no statistically significant differences between Groups A and B in any measure of cleanliness, nor tolerance and acceptability. Conclusion There are only marginal gains in small bowel cleanliness with purgatives compared with clear fluids only, mostly in the distal small bowel. The trade-off between slight improvement in distal small bowel visualisation and increased patient discomfort with purgatives should be weighed based on the specific clinical context and indication of capsule endoscopy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.006 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.005 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.006 | 0.003 |
| Insufficient payload (model declined to judge) | 0.013 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".