Baru S, Amara A, Tadros M. Letter to the Editor: Reconsidering water based boosters for small bowel capsule endoscopy. World J Gastroenterol 2026; 32(46): 124316 [DOI: 10.3748/wjg.124316]
Corresponding Author of This Article
Micheal Tadros, MD, Principal Investigator, Department of Gastroenterology and Hepatology, Albany Medical Center, 43 New Scotland Avenue, Albany, NY 12208, United States. tadrosm1@amc.edu
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Gastroenterology & Hepatology
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letter
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Baru S, Amara A, Tadros M. Letter to the Editor: Reconsidering water based boosters for small bowel capsule endoscopy. World J Gastroenterol 2026; 32(46): 124316 [DOI: 10.3748/wjg.124316]
World J Gastroenterol. Dec 14, 2026; 32(46): 124316 Published online Dec 14, 2026. doi: 10.3748/wjg.124316
Letter to the Editor: Reconsidering water based boosters for small bowel capsule endoscopy
Sriya Baru, Anokhi Amara, Micheal Tadros
Sriya Baru, Anokhi Amara, Albany Medical College, Albany, NY 12208, United States
Micheal Tadros, Department of Gastroenterology and Hepatology, Albany Medical Center, Albany, NY 12208, United States
Co-first authors: Sriya Baru and Anokhi Amara.
Author contributions: Baru S and Amara A wrote the original draft, they contributed equally to this article, they are the co-first authors of this manuscript; Baru S, Amara A, and Tadros M participated in the conceptualization and planning of the manuscript; Tadros M participated in reviewing, editing, and approving the final version; and all authors thoroughly reviewed and endorsed the final manuscript.
AI contribution statement: In accordance with the journal’s AI Tool Usage Policy, AI tools were used solely to assist with the literature search during the preparation of this manuscript. The authors carefully reviewed and independently verified all retrieved literature, interpreted the findings, and take full responsibility and accountability for the integrity, accuracy, originality, and scientific validity of the manuscript. No AI tools were used to generate scientific content, analyze data, or make scientific conclusions.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Micheal Tadros, MD, Principal Investigator, Department of Gastroenterology and Hepatology, Albany Medical Center, 43 New Scotland Avenue, Albany, NY 12208, United States. tadrosm1@amc.edu
Received: July 6, 2026 Revised: August 5, 2026 Accepted: September 23, 2026 Published online: December 14, 2026 Processing time: 131 Days and 3.6 Hours
Abstract
Ferreira et al’s in the World Journal of Gastrointestinal Endoscopy conducted a prospective, multicenter, quasi-randomized trial comparing three intraprocedural booster regimens for small bowel capsule endoscopy: Polyethylene glycol, polyethylene glycol with ascorbic acid, and still water. The study has several strengths including the prospective, multicenter design with efforts to minimize confounding, use of the validated Small Bowel Cleansing Assessment and Report scoring system with excellent interobserver agreement, and assessment of patient tolerability. Key limitations include quasi-randomization, unequal group allocation, a wide non-inferiority margin, and the lack of formal confidence interval-based analysis. In agreement with recent studies such as the PrepRICE trial, the CROHN PREP trial, and a recent umbrella meta-analysis, the findings suggest that booster timing may matter more than the agent used, though reduced cleansing in the distal small bowel with water remains a concern. Future non-inferiority trials are needed before water-based boosters can be adopted as standard practice.
Core Tip: Ferreira et al reported that a still water booster for small bowel capsule endoscopy achieved comparable bowel cleansing, diagnostic yield, and completion rates to polyethylene glycol based boosters, while significantly improving tolerability. We note several methodological strengths and limitations that may warrant closer consideration when interpreting the findings. We also place these results in the context of recent randomized trials, meta analyses, and current society guidelines, which continue to offer mixed recommendations regarding optimal SBCE preparation and booster strategies.
