Multidimensional Optimization of Small Bowel Capsule Endoscopy With Transcutaneous Electrical Acustimulation: A Randomized Controlled Trial

OBJECTIVES: To evaluate whether transcutaneous electrical acustimulation (TEA) during bowel preparation for small bowel capsule endoscopy (SBCE) can reduce the incidence of gastrointestinal adverse events (AEs), shorten gastric transit time (GTT), improve small bowel visualization quality, and enhance patient acceptability. METHODS: We prospectively enrolled outpatients scheduled for SBCE during December 2023 and March 2025. The participants were randomly allocated to receive either TEA at bilateral ST36 acupoints or sham stimulation (control) at non-acupoints during bowel preparation with split-dose polyethylene glycol. The primary outcome was the overall incidence of gastrointestinal AEs. Secondary outcomes included AE severity, small bowel visualization quality, GTT, and lesion detection rate, among others. RESULTS: A total of 39 participants completed the trial. Compared with the control group, TEA significantly reduced the overall incidence of gastrointestinal AEs during bowel preparation (p = 0.004), with particularly notable reductions in nausea and abdominal bloating. The overall severity of AEs was also markedly lower in the TEA group (p < 0.001). Furthermore, TEA significantly improved visualization quality scores for both the entire (p = 0.003) and distal small bowel (p = 0.030). GTT was significantly shorter in the TEA group (p < 0.001), and patient-reported scores for comfort (p = 0.027) and acceptability (p = 0.015) were significantly higher in the TEA group. CONCLUSIONS: TEA during SBCE bowel preparation significantly reduces gastrointestinal AEs, enhances small bowel visualization quality, and accelerates GTT. TEA is a safe and well-tolerated intervention, making it a promising adjunct to optimize SBCE.