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A PROSPECTIVE STUDY COMPARING ULTRA-LOW VOLUME BOWEL PREPARATIONS FOR CAPSULE COLONOSCOPY AND PAN-INTESTINAL CAPSULE ENDOSCOPY: EFFICACY OF 1L POLYETHYLENE GLYCOL PLUS ASCORBIC ACID VS. SODIUM PICOSSULFATE WITH MAGNESIUM CITRATE

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Introduction

Capsule colonoscopy and Pan-intestinal Capsule Endoscopy (PCE) are well-established diagnostic procedures. However, the optimal bowel preparation regimen remains undefined, with pooled adequate cleansing rates reaching only 72.5%¹. While ultra-low volume preparations (≤1L) have demonstrated efficacy in conventional colonoscopy², their effectiveness in capsule-based modalities has yet to be determined.

Aims & Methods

In this prospective, randomized, researcher-blind, single center trial, we compared the efficacy of two ultra-low volume bowel preparation regimens, 1L Polyethylene Glycol Plus Ascorbic Acid (PEG-Asc) and 1L Sodium Picossulfate with Magnesium Citrate (SPMC). Patients referred for capsule-based procedures were randomized in a 1:1 ratio to receive either PEG-Asc or SPMC. The primary endpoints were the rates of complete examinations, adequate bowel preparation, and excellent right colon cleansing.

Results

A total of 117 patients were included, referred for capsule colonoscopy due to incomplete colonoscopy (76.1%) or for PCE to assess luminal inflammation (17.9%) or anemia (6%). Overall, 61.5% were female, with a mean age of 61.3 ± 16 years. The complete examination rate was 71.8%, with no significant difference between groups (PEG-Asc 72.9% vs. SPMC 70.7%; p = 0.792). Adequate bowel preparation was achieved in 62.4% of cases, which was significantly more frequent in the PEG-Asc group (72.9%) compared to SPMC (51.7%; p = 0.018). Among complete procedures, excellent right colon cleansing was observed more often with PEG-Asc (34.1%) than with SPMC (7.3%; p = 0.003).

Conclusion

The completion and adequate preparation rates remain suboptimal in the capsule colonoscopy and PCE procedures. In this study, both ultra-low volume purgative solutions demonstrated comparable efficacy in achieving complete examinations, but the PEG-Asc resulted in significantly better overall preparation quality and superior right colon cleansing compared to SPMC. These findings suggest that PEG-Asc may be the preferred ultra-low volume regimen for optimizing bowel visualization in capsule-based examinations.

References

1. Rosa, B., Donato, H., Cúrdia Gonçalves, T., Sousa-Pinto, B. & Cotter, J. What Is the Optimal Bowel Preparation for Capsule Colonoscopy and Pan-intestinal Capsule Endoscopy? A Systematic Review and Meta-Analysis. Dig. Dis. Sci. 68, 4418–4431 (2023).
2. Arieira, C. et al. Bowel cleansing efficacy for colonoscopy: prospective, randomized comparative study of same-day dosing with 1-L and 2-L PEG + ascorbate. Endosc. Int. Open 09, E1602–E1610 (2021).

A PROSPECTIVE STUDY COMPARING ULTRA-LOW VOLUME BOWEL PREPARATIONS FOR CAPSULE COLONOSCOPY AND PAN-INTESTINAL CAPSULE ENDOSCOPY: EFFICACY OF 1L POLYETHYLENE GLYCOL PLUS ASCORBIC ACID VS. SODIUM PICOSSULFATE WITH MAGNESIUM CITRATE

Joao Carlos Goncalves 1, Ines Marques 1, Mariana Souto 1, Ana Isabel Ferreira 1, Joana Lúcia Teixeira Magalhães Magalhães 1, Bruno Rosa 1, José Berkeley Cotter 1

1 Unidade Local de Saúde do Alto Ave, Guimarães, Portugal|||Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal

Event

UEG Week Berlin 2025

Topics

Endoscopy Radiology & Imaging Colorectal

Submission format

Abstract

Session

Advances in the investigation of the small bowel

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Requirements for clinical trials and for the authorisation of new medicines in Europe

Elmer Schabel 1

1 Bundesinstitut für Arzneimittel und Medizinprodukte Abt. 2/FG Gastroenterologie, Bonn, Germany

Event

UEG Week Berlin 2025

Topics

Mechanisms & Personalised Medicine

Session

The art of making clinical research precise: Clinical research in context

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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The dynamic liver macrophage niche in health and disease: Lessons from using intravital microscopy

Moritz Peiseler 1

1 Charité University Medicine Berlin, Berlin, Germany

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Mechanisms & Personalised Medicine

Session

Challenges in metabolic liver diseases

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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PRECISION-CUT INTESTINAL SLICES PROVIDE EX VIVO ASSESSMENT OF REGION-SPECIFIC IMMUNE RESPONSES AND EFFICACY OF FILGOTINIB IN CROHN'S DISEASE

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Introduction

Inflammatory bowel disease (IBD) is a growing global health problem with increasing prevalence. Current therapeutic strategies for IBD are mainly aimed at modulating the dysregulated immune activity in the intestinal mucosa. Targeting the JAK/STAT signalling pathway has been shown to be highly effective in ulcerative colitis, but not in Crohn's disease (CD), where efficacy was found to be insufficient in the initiation phase of a clinical trial [1]. Failure of the therapeutic response in Crohn’s disease may be influenced by the unique immune microenvironments in the small and large intestine and their characteristic cytokine profiles and immune cell compositions.

Aims & Methods

To gain deeper insight into region-specific efficacy in the inflamed ileum versus colon, this study investigates the immunomodulatory effects of filgotinib, a Jak1 inhibitor, using precision-cut intestinal slices (PCIS) from patients with Crohn's diseases. PCIS are viable, ultra-thin human tissue slices that retain the original intestinal architecture ex vivo and contain important cell types, including resident immune cells.
PCIS were prepared from resected ileal and colonic tissue of CD patients. The slices were cultured ex vivo and stimulated with concanavalin A or anti-CD3/CD28 antibodies to induce T cell-driven inflammatory responses. Filgotinib (1-100 µM) was applied to assess the immunomodulatory effects of JAK1 inhibition following Concanavalin A preactivation. To exclude treatment-related toxicity, cellular integrity was evaluated using an LDH release assay. Tissue morphology was examined by H&E staining and immunofluorescence. The immune response was assessed by multiplex ELISA of 20 cytokines.

Results

After filgotinib treatment, primary tissue slices from the ileum and colon of CD patients remained viable. Regional morphological characteristics of ileum and colon tissue were preserved after ex vivo cultivation, with prominent villi and smaller crypts in the ileum, and larger, more frequent crypts and flattened villi in the colon. Compared to non-CD tissue slices, Crohn’s disease-related changes, such as immune cell accumulation, were also observed in CD tissue slices ex vivo. Upon T cell-specific stimulation with anti-CD3/CD28 antibodies, region-specific immune reactivity was observed. Colonic PCIS showed an increased release of IL-2 (~3-fold), IL-10 (~2‑fold) and TRAIL (~4-fold) compared to ileal PCIS, indicating a stronger involvement of Th and regulatory T cells in the colon. In contrast, ileal PCIS showed higher levels of MIP-3α (2-fold) and granzyme A (~8-fold) after stimulation, suggesting increased cytotoxic T cell activity in this region. Filgotinib treatment showed region-specific differences in its ability to modulate cytokine release in PCIS of CD patients. In colonic PCIS, filgotinib reduced the induced secretion of Th17-associated cytokines such as IL-17F and IL-22 by up to 95%, whereas in ileal PCIS it showed no effect on the same cytokines.

Conclusion

In conclusion, filgotinib exhibited more potent anti‑inflammatory effect on Th17 cells in the colon, and a markedly reduced efficacy in the ileum. This study demonstrates for the first time that precision-cut intestinal slices can be used to predict region-specific drug response in inflamed intestinal tissue ex vivo, underscoring the critical importance of region-specific immune profiling in IBD and highlight the limited efficacy of JAK1 inhibition in ileum. This ex vivo, patient-derived model represents a valuable platform for evaluating localised treatment efficacy and advancing personalised therapeutic strategies in IBD.