Colon capsule endoscopy (CCE) is a minimally invasive alternative to colonoscopy for colorectal cancer screening and diagnostic evaluation of the colon. A major limitation of CCE is incomplete examination, with reported complete CCE rates typically ranging from 60 to 80 %, depending on bowel preparation regimen and patient-related factors. In an interim analysis of the CareForColon2015 trial, oral administration of 2 mg prucalopride (a selective 5-HT4 receptor agonist) appeared to increase the complete CCE rate and reduce both total (mouth to anus) and colonic (caecum to anus) transit times [1]. This study aimed to validate these findings in the full cohort, asses self-reported side effects, and identify predictors of fast colonic capsule transit.

We conducted a non-randomised comparison of participants enrolled in the CareForColon2015 trial, which was conducted in Denmark from August 2020 to December 2022 [2]. The first 680 participants underwent a standard 2-day polyethylene glycol-based (Movicol and Moviprep, Norgine Danmark A/S, Herlev, Denmark) bowel preparation. The subsequent 1350 participants additionally received 2 mg prucalopride 45 to 60 minutes prior to capsule ingestion. The main exclusion criteria were conditions related to CCE contraindications, e.g. history of abdominal surgery, cardiac pacemaker, and renal insufficiency. The primary outcome was complete CCE rate defined as adequate bowel cleansing in all colorectal segments, no more than short technical interruptions, and visualization of both the caecum and anal cushions. Secondary outcomes included complete transit, conclusive CCE rate, self-reported side effects, polyp detection rate, total and colonic transit times, and overall bowel cleansing quality. Data were obtained from the capsule reports generated by the capsule readers or from participant questionnaires. Outcomes were compared between those who received prucalopride to those who did not using X² tests, Fisher’s exact tests, Student’s t-tests, or Mann-Whitney U tests depending on data type and normality.

Out of 2,031 participants, 2,024 were eligible for inclusion and complete data was available for 1,915 (94.3%). Prucalopride administration was associated with a higher complete CCE rate (63.2% versus 69.1%, p = .008). Median total transit time was decreased from 304 minutes (IQR 211 to 400) in the control group to 182 minutes (IQR 108 to 274, p < .001), representing a 40.1 % reduction. Median colonic transit time was reduced by 27.5 %, going from 153 minutes (IQR 97 to 248) in controls to 111 minutes (IQR 44 to 184, p < .001). Adequate overall bowel cleansing increased from 72.9 % to 78.2 % (p < .001). Prucalopride was associated with higher detection of polyps >9 mm (p = .037) but not detection of any polyps of any size (p = .070). Participants receiving prucalopride more frequently reported diarrhoea, headache, and fatigue. All self-reported side effects were of mild to moderate clinical significance despite potentially being relevant for patients and their acceptability of undergoing CCE. Predictors of fast colonic transit times included male sex (p < .001) for transits < 20 minutes, and male sex (p < .001), older age (p = .015), and higher BMI (p = .016) for transits < 40 minutes.

Oral administration of 2 mg prucalopride 45 to 60 minutes prior to CCE was associated with higher complete CCE rate and shorter total and colonic transit times. Prucalopride may be a simple and effective addition for CCE completeness with little self-reported side effects. The main limitation is the non-randomised study design while the primary strength is the large sample size. Randomised trials investigating optimal patient-specific dosing strategies and tolerability are warranted.