The most important aspect of a good small bowel exam with capsule endoscopy is a clean small bowel. If there is dark fluid or debris left behind after bowel prep for a colonoscopy we can usually wash and suction it clean during your procedure. With capsule endoscopy of the small bowel we don’t have this luxury. It’s up to you, the patient, to give us the cleanest small bowel you can so your physician has the best chance of giving you a good exam.
Cleaning the small bowel out isn’t as difficult as cleaning out the colon. Material in the small bowel is liquid and flushes out easier. Because of this, the prep for your small bowel exam isn’t as rigorous as it is for colonoscopy. There are several methods that work but I will discuss the one I have found to be most effective and easiest.
- The day before your scheduled small bowel exam begin a liquid diet after your morning meal. I cannot stress enough the importance of drinking plenty of fluids as it helps flush the small bowel and keeps you hydrated.
- Avoid fluids that are dark, red, blue or green as these can be hard to see through if still present in the bowel during your exam.
- Purchase the medium size bottle of Miralax (238gm) or the generic equivalent.
- Divide the contents in half and put each half in a 20 oz. or more glass of water. The night before your exam, drink one of those glasses of Miralax a couple hours before bed. You can continue to drink clear liquids up until you go to bed. The next morning, 2 hours before you are scheduled for your small bowel exam, drink the second glass of Miralax.
- You can then continue to drink water only up until you arrive at your doctor’s office for the exam. I encourage my patients to continue to drink water at this point as water filled small bowel is easier to see on the camera than a dry small bowel. Once at your doctor’s office you will swallow the capsule endoscopy. I encourage you to continue to drink some water even after you swallow the camera as it will help propel the camera along and again, gives a water filled small bowel that helps your physician see. Your physician will let you know when you can begin to eat solid food.
Russell Dean Havranek, MD is a gastroenterologist at Gastroenterology Clinic of San Antonio