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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
Low-volume bowel preparation provides safe and effective pan-enteric capsule endoscopy in suspected or established Crohn’s disease
Snir Livne, Nathaniel Aviv Cohen, Naomi Fliss-Isakov, Moshe Leshno, Nitsan Maharshak, Eva Niv, Liat Deutsch
Snir Livne, Nathaniel Aviv Cohen, Nitsan Maharshak, Eva Niv, Liat Deutsch, School of Medicine, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
Nathaniel Aviv Cohen, Naomi Fliss-Isakov, Nitsan Maharshak, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
Naomi Fliss-Isakov, Department of Health Promotions, School of Public Health, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
Moshe Leshno, The Coller School of Management, Tel Aviv University, Tel Aviv 6997801, Israel
Eva Niv, Department of Gastroenterology, Meuhedet Health Services, Hadera 38100, Haifa, Israel
Liat Deutsch, Clinical Nutrition and Capsule Endoscopy Service, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
Author contributions: Livne S, Fliss-Isakov N, Leshno M, and Deutsch L designed the study; Livne S, Cohen NA, and Deutsch L performed the research and acquired the data; Livne S, Fliss-Isakov N, Leshno M, and Deutsch L analyzed and interpreted the data; Livne S and Deutsch L wrote the manuscript; Cohen NA, Fliss-Isakov N, Leshno M, Maharshak N, Niv E, and Deutsch L revised the article critically for important intellectual content. All authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of Tel Aviv Sourasky Medical Center (No. 0407-21-TLV).
Informed consent statement: Informed consent for participating in the study was waived.
Conflict-of-interest statement: Niv E serves as a consultant for Medtronic; Deutsch L has received past consulting and lecturing fees from Medtronic; However, the company was not involved in any aspect of this study. All other authors (Livne S, Cohen NA, Fliss-Isakov N, Leshno M, and Maharshak N) declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Dataset available from the corresponding author at
liatml@tlvmc.gov.il on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Liat Deutsch, MD, Head, Clinical Nutrition and Capsule Endoscopy Service, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel.
liatml@tlvmc.gov.il
Received: August 11, 2025
Revised: October 7, 2025
Accepted: December 2, 2025
Published online: January 16, 2026
Processing time: 157 Days and 13.8 Hours
BACKGROUND
Effective pan-enteric capsule endoscopy (PCE) visualization requires thorough bowel preparation. We hypothesized that a novel low-volume protocol (LVP) provides comparable safety and effectiveness to the standard high-volume protocol (HVP).
AIM
To evaluate the safety and effectiveness of a novel low-volume vs standard high-volume preparation protocol for PCE.
METHODS
We conducted an observational study including all prospectively documented PCEs at our tertiary center (2018-2021), comparing preparation adequacy and completion rates between patients receiving LVP vs HVP. Preparation adequacy was evaluated by two blinded expert readers (Cohen’s kappa, correlation tests). Finally, an individual participant data meta-analysis combining our cohort with three published cohorts assessed PCE outcomes with HVP vs LVP. A P value < 0.05 was considered statistically significant in all tests.
RESULTS
Our analysis included 67 patients: 12 (17.9%) underwent PCE with HVP, and 55 (82.1%) with LVP. No post-PCE complications were reported. PCE completion was achieved by 89.1% of the LVP group and 75.0% of the HVP group. Adequate small bowel and colonic preparation rates were comparable between the HVP and LVP groups (90.9% vs 89.1%, and 80.0% vs 90.0%, respectively). In our individual patient data meta-analysis, the combined HVP (n = 257) and the LVP (n = 55) were comparable regarding completion rates (87.2% vs 89.1%) and adequate small bowel preparation rates (90.0% vs 89.1%); however, LVP had higher rates of adequate colonic preparation vs combined HVP (80.0% vs 62.7%, respectively, P = 0.017).
CONCLUSION
LVP is a safe and effective alternative to HVP with similar completion rates, better colonic preparation, and lower volume, making it preferable for patients with suspected or diagnosed Crohn’s disease.
Core Tip: This study evaluates a novel low-volume, sulfate-free bowel preparation protocol for pan-enteric capsule endoscopy compared to the standard high-volume protocol. Despite the substantially lower volume, low-volume protocol (LVP) achieved comparable completion rates and adequate colonic cleansing. A pooled analysis across cohorts supports these findings and suggests improved colonic visualization with LVP over high-volume protocol. LVP may therefore represent a safe, effective, and potentially more patient-friendly alternative for pan-enteric capsule endoscopy preparation, particularly in the evaluation of Crohn’s disease.
