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O'Hara FJ, Costigan C, Mc Namara D. Orally peppermint oil in small bowel capsule endoscopy: Novel approach to improve completion rates in patients at risk of delayed gastric transit. Endosc Int Open 2025; 13:a24656918. [PMID: 40109317 PMCID: PMC11922309 DOI: 10.1055/a-2465-6918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 11/11/2024] [Indexed: 03/22/2025] Open
Abstract
Background and study aims Small bowel capsule endoscopy (SBCE) is crucial in diagnosing small bowel diseases, yet incomplete examinations often result from prolonged gastric transit time. This study aimed to assess the efficacy of orally administered peppermint oil solution as a prokinetic agent to improve SBCE completion rates in patients with delayed gastric transit risk factors. Patients and methods Conducted as a single-center, prospective, open-label, non-inferiority trial, the study involved 132 patients identified as at risk for delayed gastric transit. Participants were divided into three groups: peppermint oil solution group (n = 57), real-time monitoring and intravenous prokinetics group (n = 75), and control group without risk factors (n = 193). Primary outcomes included SBCE completion rates, gastric transit time (GTT), small bowel transit time (SBTT), diagnostic yield, and bowel preparation quality. Results Completion rates were high and comparable among groups, with 94.7% in the peppermint group, 90.7% in the real-time monitoring group, and 95.3% in the control group. The peppermint group exhibited a significantly shorter mean GTT of 42.3 minutes compared with 57.0 minutes in the real-time monitoring group ( P = 0.0423). However, SBTT was longer in the peppermint group at 246 minutes versus 193 minutes in the real-time monitoring group ( P = 0.0081), although similar to the control group at 228.3 minutes ( P = 0.2612). Diagnostic yield and bowel preparation quality were consistent across all groups. Conclusions Oral peppermint oil solution is a safe and effective alternative to traditional prokinetics, enhancing SBCE completion rates while reducing time and resource use in the endoscopy unit.
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Affiliation(s)
| | - Conor Costigan
- Gastroenterology, Tallaght University Hospital, Dublin, Ireland
- Gastroenterology, Trinity College Dublin, Dublin, Ireland
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Odah T, Vattikonda A, Stark M, Brahmbhatt B, Lukens FJ, Badurdeen D, Hashash JG, Farraye FA. Glucagon-like peptide-1 receptor agonists and capsule endoscopy in patients with diabetes: a matched cohort study. Gastrointest Endosc 2025; 101:393-401. [PMID: 39094916 DOI: 10.1016/j.gie.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/05/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND AND AIMS Video capsule endoscopy (VCE) is valuable for assessing conditions like GI bleeding, anemia, and inflammatory bowel disease. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are prescribed for diabetes and weight loss, with their pharmacologic effects including delayed gastric emptying. This study investigates the impact of GLP-1RA use on VCE outcomes in patients with diabetes. METHODS This retrospective cohort study involves patients with diabetes undergoing VCE while on GLP-1RAs matched in a 1:1 ratio with control subjects, who are not on GLP-1RAs, based on demographics and diabetes-related factors. The primary outcome was gastric transit time in VCE studies, whereas secondary outcomes were incomplete small-bowel evaluation and small-bowel transit time. RESULTS In the GLP-1RA cohort with 68 patients, 5 (7%) experienced failure to pass the video capsule through the stomach; all control subjects passed the video capsule successfully (P = .06). GLP-1RA patients had a longer gastric transit time (99.3 ± 134.2 minutes) compared with control subjects (25.3 ± 31.6 minutes, P < .001). Multivariate analysis revealed GLP-1RA use was associated with an increased gastric transit time by 74.5 minutes (95% confidence interval, 33.8-115.2; P < .001) compared with control subjects, after adjusting for relevant factors. Sixteen GLP-1RA patients (23.5%) experienced incomplete passage of the video capsule through the small intestine, a significantly higher rate compared with 3 patients in the control group (4.4%, P < .01). CONCLUSIONS GLP-1RA use is associated with a prolonged gastric transit time and a higher rate of incomplete small-bowel evaluation during VCE. Future studies may be crucial for evaluating strategies to mitigate these effects.
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Affiliation(s)
- Tarek Odah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Asrita Vattikonda
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark Stark
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Frank J Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jana G Hashash
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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St‐Jean C, Collier A, Zur Linden A, Bersenas A, Defarges A. Feasibility and complications of videocapsule endoscopy in dogs weighing 7 kg or less. J Vet Intern Med 2025; 39:e17286. [PMID: 39792325 PMCID: PMC11720729 DOI: 10.1111/jvim.17286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 12/04/2024] [Indexed: 01/12/2025] Open
Abstract
BACKGROUND Videocapsule endoscopy (VCE) is a valuable tool for investigating gastrointestinal (GI) diseases in dogs. Its use is not recommended in dogs ≤4.3 kg, because of risks of GI endoscopic capsule (EC) retention and bowel obstruction. OBJECTIVES Describe the feasibility and complications of VCE in dogs ≤7 kg. ANIMALS Twenty-six client-owned dogs. METHODS Retrospective study describing the signalment, previous GI imaging, indications, findings, and complications of canine VCE studies submitted to Infiniti Medical between March 2020 and January 2023. RESULTS The median weight and age of dogs was 5.6 kg (range, 3-7) and 8.8 years (range, 1-16), respectively. Two capsules were administered endoscopically into the duodenum (1) and stomach (1). Sixteen out of 26 (62%, 95% CI, 40.51-79.70) dogs that underwent VCE had incomplete studies. Of the 24 capsules administered per os, 15 led to incomplete studies (battery died in the stomach (14), EC was vomited (1)). Body weight <5 kg significantly increased the risk of an incomplete study (OR: 3.67, 95% CI, 1.56-inf, P = .0074). Median esophageal, gastric, and small bowel transit time were 5 seconds (range, 1-180), 240 minutes (range, 17-335), and 73.5 minutes (range, 5-168), respectively. All 10 dogs with overt GI bleeding had a possible origin identified with VCE. Complications were limited to vomiting (1/26, 3.85%, 95% CI, 0-11.20). CONCLUSIONS AND CLINICAL IMPORTANCE Videocapsule endoscopy is a safe and informative procedure even when performed in dogs as small as 3 kg. However, weighing <5 kg increases the risk of incomplete studies.
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Affiliation(s)
- Camille St‐Jean
- Department of Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | - Allison Collier
- Department of Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | - Alex Zur Linden
- Department of Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | - Alexa Bersenas
- Department of Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | - Alice Defarges
- Department of Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
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Ouazana S, Baltes P, Toth E, Lüttge H, Nemeth A, Beaumont H, González-Suárez B, Lee PS, Carretero C, Margalit Yehuda R, Elli L, Spada C, Bruno M, Mussetto A, Cortegoso Valdivia P, Becq A, Corbett G, Martin A, Robertson A, Benamouzig R, Despott E, Riccioni ME, Sidhu R, Calavas L, Ellul P, Finta A, Triantafyllou K, Rondonotti E, Kirchgesner J, Elosua A, McNamara D, Dray X. Endoscopic GI placement of capsule endoscopy to investigate the small bowel: a multicenter European retrospective series of 630 procedures in adult patients. Gastrointest Endosc 2024; 100:492-500. [PMID: 38272273 DOI: 10.1016/j.gie.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/29/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND AND AIMS Small-bowel (SB) capsule endoscopy (CE) is a first-line procedure for exploring the SB. Endoscopic GI PlacemenT (EGIPT) of SB CE is sometimes necessary. Although experience with EGIPT is considerable in pediatric populations, we aimed to describe the safety, efficacy, and outcomes of EGIPT of SB CE in adult patients. METHODS The international CApsule endoscopy REsearch (iCARE) group set up a retrospective multicenter study. Patients over age 18 years who underwent EGIPT of SB CE before May 2022 were included. Data were collected from medical records and capsule recordings. The primary endpoint was the technical success rate of the EGIPT procedures. RESULTS Of 39,565 patients from 29 centers, 630 (1.6%) were included (mean age, 62.5 years; 55.9% women). The technical success of EGIPT was achieved in 610 procedures (96.8%). Anesthesia (moderate to deep sedation or general anesthesia) and centers with intermediate or high procedure loads were independent factors of technical success. Severe adverse events occurred in 3 patients (.5%). When technically successful, EGIPT was associated with a high SB CE completion rate (84.4%) and with a substantial diagnostic yield (61.1%). The completion rate was significantly higher when the capsule was delivered in the SB compared with when it was delivered in the stomach. CONCLUSIONS EGIPT of SB CE is highly feasible and safe, with a high completion rate and diagnostic yield. When indicated, it should be performed with patients under anesthesia, and the capsule should be delivered in the duodenum rather than the stomach for better SB examination outcomes.
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Affiliation(s)
- Salome Ouazana
- Center for digestive endoscopy, Sorbonne University, Saint Antoine Hospital, APHP Paris, Paris, France
| | - Peter Baltes
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Hannah Lüttge
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Artur Nemeth
- Department of Gastroenterology, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Hanneke Beaumont
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Begoña González-Suárez
- Endoscopy Unit, Gastroenterology Department, ICMiD, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Phey Shen Lee
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, NE34 0PL, UK
| | - Cristina Carretero
- Department of Gastroenterology, University of Navarre Clinic, Healthcare Research Institute of Navarre, Pamplona, Spain
| | - Reuma Margalit Yehuda
- Department of Gastroenterology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Mauro Bruno
- Gastroenterology and Digestive Endoscopy Unit, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | | | | | - Aymeric Becq
- Gastroenterology and Endoscopy Department, University Hospital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 94000, Créteil, France
| | - Gareth Corbett
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, UK
| | - Antoine Martin
- Gastroenterology Unit, Bicetre Hospital, Le Kremlin-Bicêtre, France
| | - Alexander Robertson
- Department of Gastroenterology, Western General Hospital, Edinburgh EH4 2XU, UK
| | | | - Edward Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK
| | - Maria Elena Riccioni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Reena Sidhu
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Laura Calavas
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, MSD 2090 Msida, Malta
| | - Adam Finta
- Department of Gastroenterology, Endo-Kapszula Health Center and Endoscopy Unit, Székesfehérvár 8000, Hungary
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal, Attikon University General Hospital, Athens, Greece
| | | | - Julien Kirchgesner
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alfonso Elosua
- Gastroenterology Unit, Hospital García Orcoyen, 31200 Estella, Spain
| | - Deirdre McNamara
- Department of Gastroenterology, Tallaght University Hospital and School of Medicine Trinity College Dublin, Dublin, Ireland
| | - Xavier Dray
- Center for digestive endoscopy, Sorbonne University, Saint Antoine Hospital, APHP Paris, Paris, France
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Macedo Silva V, Lima Capela T, Freitas M, Arieira C, Xavier S, Boal Carvalho P, Rosa B, Moreira MJ, Cotter J. Stepping it up: Physical activity is associated with a lower incidence of prolonged gastric transit time in capsule endoscopy. J Gastroenterol Hepatol 2023; 38:404-409. [PMID: 36409269 DOI: 10.1111/jgh.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/05/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Physical activity has been proposed as a potential factor influencing capsule endoscopy (CE) gastric transit time (GTT). However, there is no reported factual evidence confirming this association. We aimed to prospectively assess the effect of physical activity in the first hour of CE in the occurrence of prolonged GTT. METHODS This is a prospective study including consecutive patients undergoing CE. For each patient, a step counter was attached to the CE register. The number of steps during the first hour of the procedure was registered. The main outcome was prolonged GTT (CE remaining in the stomach for > 1 h). Outcomes were adjusted for possible confounders by multivariate analysis. RESULTS We included 100 patients, 60% undergoing small bowel CE and 40% colon CE. The mean number of steps in the first hour was significantly lower in patients with prolonged GTT (2009 ± 1578 steps) comparatively with those without prolonged GTT (3597 ± 1889 steps) (P < 0.001). On multivariate analysis including significant confounders, steps in the first hour were an independent predictor of prolonged GTT (P = 0.018). Single-handedly, the number of steps taken in the first hour had a good acuity for predicting prolonged GTT (area under the curve = 0.74; P < 0.001), with an optimal cut-off of 2000 steps (sensitivity 81.3% and specificity 70%). CONCLUSIONS Physical activity during the first hour of CE significantly decreased the occurrence of prolonged GTT. These findings pave the way for further definition of clear instructions to give to patients undergoing CE.
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Affiliation(s)
- Vítor Macedo Silva
- Gastroenterology Department, Hospital of Our Lady of Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Portugal
| | - Tiago Lima Capela
- Gastroenterology Department, Hospital of Our Lady of Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Portugal
| | - Marta Freitas
- Gastroenterology Department, Hospital of Our Lady of Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Portugal
| | - Cátia Arieira
- Gastroenterology Department, Hospital of Our Lady of Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Portugal
| | - Sofia Xavier
- Gastroenterology Department, Hospital of Our Lady of Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital of Our Lady of Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital of Our Lady of Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Portugal
| | - Maria João Moreira
- Gastroenterology Department, Hospital of Our Lady of Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital of Our Lady of Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Guimarães, Portugal
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Zeng X, Ye L, Liu J, Yuan X, Jiang S, Huang M, Huang X, Tang C, Hu B. Value of the diving method for capsule endoscopy in the examination of small-intestinal disease: a prospective randomized controlled trial. Gastrointest Endosc 2021; 94:795-802.e1. [PMID: 33932461 DOI: 10.1016/j.gie.2021.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Video capsule endoscopy (VCE) is limited by poor image quality and incomplete small-bowel transit. This study was designed to evaluate the diving method for VCE in the examination of small-intestinal disease. METHODS From July 2017 to September 2017, eligible patients were randomly assigned to 2 groups, the diving group and the control group. For the diving group, 500 mL of water was administered every hour when the capsule reached the small bowel. The primary outcomes were image quality and positive findings. Secondary outcomes were the completion rate of examination, gastric transit time (GTT), small-bowel transit time (SBTT), lesion detection rate, adverse events, and patient satisfaction. RESULTS One hundred forty patients were included. The scores of endoscopic images in the proximal third and middle third of the small bowel in the diving group were significantly higher than that in the control group (3.47 ± .60 vs 3.11 ± .63 [P = .007] and 3.24 ± .59 vs 2.78 ± .74 [P = .002], respectively). The positive findings in the distal third of the small bowel were significantly different between the 2 groups (P = .005). The completion rate in the diving group was significantly higher (92.19% vs 76.32%, respectively; P = .012). The GTT, SBTT, and lesion detection rate were similar in 2 groups (P = .282, .067, and .577, respectively). No discomfort or adverse events were reported except for a few cases of frequent urination. CONCLUSIONS The diving method for VCE examination effectively improves the endoscopic view in the proximal and middle thirds of the small bowel and the positive findings in the distal small intestine and increases the completion rate. (Clinical trial registration number: ChiCTR-RDR-17011823.).
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Affiliation(s)
- Xianhui Zeng
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Liansong Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianrong Liu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Xianglei Yuan
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Shan Jiang
- Intensive Care Unit, Hospital of the Office of the Tibet Autonomous Region People's Government in Chengdu, Chengdu, China
| | - Minghui Huang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiujiang Huang
- Department of Gastroenterology, The People's Hospital of the Qiandongnan Miao and Dong Autonomous Prefecture, Kaili, Guizhou, China
| | - Chengwei Tang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
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Lavage, Simethicone, and Prokinetics-What to Swallow with a Video Capsule. Diagnostics (Basel) 2021; 11:diagnostics11091711. [PMID: 34574051 PMCID: PMC8465944 DOI: 10.3390/diagnostics11091711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022] Open
Abstract
The development of new capsules now allows endoscopic diagnosis in all segments of the gastrointestinal tract and comes with new needs for differentiated preparation regimens. Although the literature is steadily increasing, the results of the conducted trials on preparation are sometimes conflicting. The ingestion of simethicone before gastric and small bowel capsule endoscopy for prevention of air bubbles is established. The value of a lavage before small bowel capsule endoscopy (SBCE) is recommended, although not supported by all studies. Ingestion in the morning before the procedure seems useful for the improvement of mucosa visualization. Lavage after swallowing of the capsule seems to improve image quality, and in some studies also diagnostic yield. Prokinetics has been used with first generation capsules to shorten gastric transit time and increase the rate of complete small bowel visualization. With the massively prolonged battery capacity of the new generation small bowel capsules, prokinetics are only necessary in significantly delayed gastric emptying as documented by a real-time viewer. Lavage is crucial for an effective colon capsule or pan-intestinal capsule endoscopy. Mainly high or low volume polyethylene glycol (PEG) is used. Apart from achieving optimal cleanliness, propulsion of the capsule by ingested boosts is required to obtain a complete passage through the colon within the battery lifetime. Boosts with low volume sodium picosulfate (NaP) or diatrizoate (gastrografin) seem most effective, but potentially have more side effects than PEG. Future research is needed for more patient friendly but effective preparations, especially for colon capsule and pan-intestinal capsule endoscopy.
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Song HJ. [Optimal Bowel Preparation for Capsule Endoscopy and Device-assisted Enteroscopy]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 75:74-78. [PMID: 32098460 DOI: 10.4166/kjg.2020.75.2.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/18/2022]
Abstract
For improved examination of video capsule endoscopy (VCE) and device-assisted enteroscopy (DAE), bowel preparation is an essential issue. Multiple factors like air bubbles, food material in the small bowel, and gastric and small bowel transit time affect the small bowel visualization quality (SBVQ), diagnostic yield (DY) and cecal completion rate (CR). Bowel preparation with polyethylene glycol (PEG) solution enhances SBVQ and DY, but it has no effect on CR. Bowel preparation with PEG solution 2 L is similar to PEG 4 L in SBVQ, DY, and CR. Bowel preparation with fasting or PEG solution combined with anti-foaming agents like simethicone enhance SBVQ, but it has no effect on CR. Bowel preparation with prokinetics is not commonly recommended. Optimal timing for purgative bowel preparation has yet to be established. However, the studies regarding bowel preparation for DAE are not sufficient. European Society of Gastrointestinal Endoscopy (ESGE) recommends 8-12 hours fasting from solid food and 4-6 hours fasting from liquids prior to the antegrade DAE. For retrograde DAE, colonoscopy preparation regimen is recommended. This article reviews the literature and ESGE, 2013 Korean published guidelines regarding bowel preparation for VCE and DAE, following suggestion for optimal bowel preparation for VCE and balloon enteroscopy.
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Affiliation(s)
- Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Squirell E, Ricci M, Hookey L. Preparation, Timing, Prokinetics, and Surface Agents in Video Capsule Endoscopy. Gastrointest Endosc Clin N Am 2021; 31:251-265. [PMID: 33743924 DOI: 10.1016/j.giec.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
There is a trend in data to support active preparation for video capsule endoscopy (VCE), but the timing of this remains unclear. Split dosing may be the most efficacious preparation. Study methodology continues to evolve, with increased use of standardized scales, with the addition of diagnostic yield as an outcome. The use of adjuncts has not been detrimental, but their value has not been proved to improve outcomes of VCE.
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Affiliation(s)
- Elizabeth Squirell
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Michelle Ricci
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lawrence Hookey
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada; Division of Gastroenterology, Hotel Dieu Hospital, 166 Brock Street, Kingston, Ontario K7L 5G2, Canada.
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Wu J, Ye Z, Xue A, Huang Y. Can domperidone decrease transit time of pediatric video capsule endoscopy? A randomized controlled trial. Transl Pediatr 2021; 10:344-349. [PMID: 33708520 PMCID: PMC7944175 DOI: 10.21037/tp-20-273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The complete examination rate of video capsule endoscopy can be increased by reduced gastric transit time (GTT) and or small bowel transit time (SBTT). This study aims to examine whether the prokinetic domperidone reduces GTT and/or SBTT in pediatric patients undergoing video capsule endoscopy (VCE). METHODS We performed a single-center randomized controlled trial (n=200) to evaluate the effect of domperidone on GTT and SBTT among pediatric patients in a tertiary university-affiliated hospital for children. We explored whether patients randomized to domperidone had increased GTT, SBTT (primary outcomes) or higher complete examination rate (secondary outcome). The safety outcomes were the adverse effects in the domperidone group. This study was registered on ClinicalTrials.gov (NCT03662113). RESULTS Demographic features including gender and age were similar between the 100 patients of the domperidone group and the 100 patients of the control group. The median GTT was 67.5 minutes (44.8-117.5) in the domperidone group and 80.0 minutes (42.0-128.0) in the control group, while the median SBTT was 317 minutes (231-436) and 323 minutes (225-426), respectively. There were no significant differences in GTT (P=0.49) and SBTT (P=0.52) between the two groups. The complete examination rate was 97% and 98% in the domperidone and control groups, respectively (P=1.00). CONCLUSIONS Domperidone shows no effect on GTT, SBTT and complete examination rate in pediatric patients receiving VCE.
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Affiliation(s)
- Jie Wu
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Ziqing Ye
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Aijuan Xue
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Ying Huang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
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Wang YC, Pan J, Liu YW, Sun FY, Qian YY, Jiang X, Zou WB, Xia J, Jiang B, Ru N, Zhu JH, Linghu EQ, Li ZS, Liao Z. Adverse events of video capsule endoscopy over the past two decades: a systematic review and proportion meta-analysis. BMC Gastroenterol 2020; 20:364. [PMID: 33138792 PMCID: PMC7607645 DOI: 10.1186/s12876-020-01491-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/07/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A full spectrum of video capsule endoscopy (VCE) adverse events over the past two decades has not been evaluated. We aimed to determine pooled rates, predictors and temporal-trend of VCE adverse events over the past two decades. METHODS Systematic search of PubMed and EMBASE for English-language publications reporting VCE adverse events (January 1, 2000 to March 31, 2019). Data were extracted independently by two investigators. Pooled VCE adverse event rates were calculated using the random or fixed model as appropriate. Predictors and temporal-trend of each adverse event were performed by meta-regression analyses. RESULTS In total, 402 studies were identified, including 108,079 VCE procedures. Rate of retention, swallow disorder, aspiration, technical failure, and procedural adverse events were 0.73% (95% confidence interval [CI] 0.59-0.89%), 0.75% (95% CI 0.43-1.13%), 0.00% (95% CI 0.00-0.00%), 0.94% (95% CI 0.65-1.28%), 0.67% (95% CI 0.32-1.10%), respectively; incomplete examination rate of esophagus, stomach, small bowel, and colon were 9.05%, 7.69%, 12.08%, 19.19%, respectively. Patency capsule reduced retention rate by 5.04%, whereas known inflammatory bowel disease increased retention rate by 4.29%. Elder was the risk and protective factor for small bowel incomplete examination (0.30%) and swallow disorder (- 0.72%), respectively. Rates of retention and small bowel incomplete examination significantly declined over time (P = .0006 and P < .0001).. CONCLUSIONS VCE adverse event rates were generally low, and retention and small bowel incomplete examination rates declined over the past two decades. Patients with known inflammatory bowel disease or elder should be alerted to high risk of retention or small bowel incomplete examination (PROSPERO: CRD42019139595).
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Affiliation(s)
- Yuan-Chen Wang
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Jun Pan
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Ya-Wei Liu
- Department of Gastroenterology, The First Medical Center of PLA General Hospital/Chinese PLA Postgraduate Military Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Feng-Yuan Sun
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Yang-Yang Qian
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Xi Jiang
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Wen-Bin Zou
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Ji Xia
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Bin Jiang
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Nan Ru
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Jia-Hui Zhu
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - En-Qiang Linghu
- Department of Gastroenterology, The First Medical Center of PLA General Hospital/Chinese PLA Postgraduate Military Medical School, 28 Fuxing Road, Beijing, 100853, China.
| | - Zhao-Shen Li
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China
| | - Zhuan Liao
- National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.
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Hosoe N, Takabayashi K, Ogata H, Kanai T. Capsule endoscopy for small-intestinal disorders: Current status. Dig Endosc 2019; 31:498-507. [PMID: 30656743 DOI: 10.1111/den.13346] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/09/2019] [Indexed: 12/13/2022]
Abstract
Small-bowel capsule endoscopy (SBCE) is used widely because of its non-invasive and patient-friendly nature. SBCE can visualize entire small-intestinal mucosa and facilitate detection of small-intestinal abnormalities. In this review article, we focus on the current status of SBCE. Several platforms for SBCE are available worldwide. Third-generation SBCE (PillCam® SB3) has a high-resolution camera equipped with an adaptive frame rate system. Several software modes have been developed to reduce the reading time for capsule endoscopy and to minimize the possibility of missing lesions. The main complication of SBCE is capsule retention. Thus, the main contraindication for SBCE is known or suspected gastrointestinal obstruction unless intestinal patency is proven. Possible indications for SBCE are obscure gastrointestinal bleeding, Crohn's disease, small-intestinal polyps and tumors, and celiac disease. Colon capsule endoscopy (CCE) can observe inflamed colonic mucosa non-invasively, and allows for the continuous and non-invasive observation of the entire intestinal tract (pan-endoscopy). Recently, application of CCE as pan-enteric endoscopy for inflammatory bowel diseases (including Crohn's disease) has been reported. In the near future, reading for CE will be assisted by artificial intelligence, and reading CE videos for long periods will not be required.
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Affiliation(s)
- Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
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Egea Valenzuela J, Sánchez Martínez A, García Marín AV, Alberca de Las Parras F. Influence of demographic and clinical features of the patient on transit times and impact the on the diagnostic yield of capsule endoscopy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:530-536. [PMID: 31140286 DOI: 10.17235/reed.2019.5971/2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND transit times in the gastric cavity and the small bowel can be easily calculated using capsule endoscopy software. The factors that can influence these times and impact on diagnostic yield have not been completely assessed. AIMS to analyze the influence of demographic and clinical features on transit times and the impact on diagnostic yield. METHODS a retrospective, single-center study of examinations between January 2013 and November 2017 was performed. The analyzed features included gender, age, body mass index, diabetes, thyroid disease and indications. The association and correlation between the variables were assessed, as well as the presence of positive and significant findings. RESULTS six hundred and thirty-one patients were included in the study. Gastric and small bowel transit times were 36.10 ± 48.50 and 251.82 ± 116.42 minutes, respectively. Gastric time was not affected by any of the variables. Small bowel time was longer in males, patients over 60 years of age and diabetics. Prolonged small bowel time, male gender and older age were associated with a higher diagnostic yield. Age over 60 years was the only factor independently associated with positive findings (OR: 1.550 [1.369-1.754]; p: 0.007). CONCLUSIONS patients over 60 years have a longer small bowel transit time and higher probability of having small bowel lesions. Males and diabetic patients also seem more likely to have longer transit times and higher rates of positive findings.
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Affiliation(s)
- Juan Egea Valenzuela
- Servicio de Medicina del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixa, España
| | - Ana Sánchez Martínez
- Servicio de Medicina del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, España
| | - Ana Victoria García Marín
- Servicio de Medicina del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, España
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Sakurai T, Fujimori S, Hayashida M, Hanada R, Akiyama J, Sakamoto C. Repeatability of small bowel transit time in capsule endoscopy in healthy subjects. Biomed Mater Eng 2018; 29:839-848. [PMID: 30282338 DOI: 10.3233/bme-181027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are no reports to prove the repeatability of gastric transit time (GTT) and small bowel transit time (SBTT) in capsule endoscopy (CE). OBJECTIVE To clarify the repeatability and factors that affect GTT/SBTT in CE. METHODS We analyzed the data of 150 healthy subjects from our previous randomized controlled trial that compared small intestinal injuries between two 14-day treatment groups: 1) celecoxib and 2) loxoprofen + lansoprazole. Correlation of GTT/SBTT with pre- and post-treatment CE was analyzed. In addition, the associations of pre-treatment CE SBTT with physical factors, post-treatment CE SBTT and the presence of small intestinal mucosal injuries were analyzed. RESULTS Analyses of 148 subjects pre-treatment CE and 146 subjects post-treatment CE were performed. There were no significant differences between mean GTT and SBTT before and after treatment. Both GTT (𝜌 = 0.22, p < 0.01) and SBTT (𝜌 = 0.47, p < 0.0001) showed positive correlations between pre- and post-treatment CE. In pre-treatment CE, physical factors and the presence of small intestinal mucosal injury had no associations with SBTT. CONCLUSIONS Moderate correlation in SBTT and slight correlation in GTT were shown on repeated CE. The factors affecting SBTT were not clarified in this analysis.
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Affiliation(s)
- Toshiyuki Sakurai
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Shunji Fujimori
- Department of Gastroenterology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Mari Hayashida
- The Third Department of Internal Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Ryuzo Hanada
- SOUEIKAI, Sumida Hospital, 1-29-1, Honjo, Sumida-ku, Tokyo, 130-0004, Japan
| | - Junichi Akiyama
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Choitsu Sakamoto
- Department of Gastroenterology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Prichard D, Ou G, Galorport C, Enns R. Sham Feeding with Bacon Does Not Alter Transit Time or Complete Examination Rate During Small Bowel Capsule Endoscopy. Dig Dis Sci 2018; 63:422-428. [PMID: 29302875 DOI: 10.1007/s10620-017-4901-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/22/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND During capsule endoscopy (CE) studies, the complete examination rate (CER) can be increased by prolonging capsule battery life or reducing gastric transit time (GTT) and/or small bowel transit time (SBTT). However, despite enhanced battery life, 10% of studies remain incomplete. Previously studied interventions to reduce SBTT and enhance CER have produced conflicting results. We hypothesize that this may be a consequence of an insufficiently potent stimulus of small bowel motility. AIMS To examine whether potent stimulation of the cephalic response of digestion during small bowel CE reduces GTT and/or SBTT and thus increases the CER. METHODS A single-blind randomized trial was performed to evaluate the effect of bacon sham feeding on GTT, SBTT and CER. RESULTS Baseline characteristics were similar between 63 sham fed patients and 59 controls. The median GTT was 17 min (9-65) in the bacon group and 25 min (14-55) in the control group. The median SBTT was 199 min (119-316) and 222 min (151-287), respectively. Cox proportional hazards model demonstrated no significant difference between groups for GTT (rate ratio 1.03, 95% CI 0.71-1.51, P = 0.87) or SBTT (rate ratio 1.02, 95% CI 0.70-1.49, P = 0.93). Although the taste of bacon was considered favorably by 72% of participants, taste did not correlate with GTT (ρ = 0.03, P = 0.83) or SBTT (ρ = - 0.115, P = 0.33). The CER was 91 and 95% in the bacon and control groups, respectively (P = 0.35). CONCLUSION Bacon sham feeding has no effect on GTT, SBTT or CER and cannot be recommended in clinical practice.
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Affiliation(s)
- David Prichard
- Mayo Clinic Health System Franciscan Healthcare in La Crosse, 700 West Avenue South, La Crosse, WI, 54601, USA. .,St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
| | - George Ou
- St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Cherry Galorport
- St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Robert Enns
- St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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Shim KN, Jeon SR, Jang HJ, Kim J, Lim YJ, Kim KO, Song HJ, Lee HS, Park JJ, Kim JH, Chun J, Park SJ, Yang DH, Min YW, Keum B, Lee BI. Quality Indicators for Small Bowel Capsule Endoscopy. Clin Endosc 2017; 50:148-160. [PMID: 28391667 PMCID: PMC5398361 DOI: 10.5946/ce.2017.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/14/2017] [Accepted: 03/16/2017] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopy (CE) enables evaluation of the entire mucosal surface of the small bowel (SB), which is one of the most important steps for evaluating obscure gastrointestinal bleeding. Although the diagnostic yield of SB CE depends on many clinical factors, there are no reports on quality indicators. Thus, the Korean Gut Image Study Group (KGISG) publishes an article titled, “Quality Indicators for Small Bowel Capsule Endoscopy” under approval from the Korean Society of Gastrointestinal Endoscopy (KSGE). Herein, we initially identified process quality indicators, while the structural and outcome indicators are reserved until sufficient clinical data are accumulated. We believe that outcomes of SB CE can be improved by trying to meet our proposed quality indicators.
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Affiliation(s)
- Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seong Ran Jeon
- Department of Internal Medicine,Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun Joo Jang
- Department of Internal Medicine, Hallym University College of Medicine, Hwaseong, Korea
| | - Jinsu Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea
| | - Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Seok Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Jun Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Jaeyoung Chun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Jung Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bora Keum
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Bo-In Lee
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
Wireless capsule endoscopy (CE) was introduced in 2000 as a less invasive method to visualize the distal small bowel in adults. Because this technology has advanced it has been adapted for use in pediatric gastroenterology. Several studies have described its clinical use, utility, and various training methods but pediatric literature regarding CE is limited. This clinical report developed by the Endoscopic and Procedures Committee of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition outlines the current literature, and describes the recommended current role, use, training, and future areas of research for CE in pediatrics.
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Girelli CM, Soncini M, Rondonotti E. Implications of small-bowel transit time in the detection rate of capsule endoscopy: A multivariable multicenter study of patients with obscure gastrointestinal bleeding. World J Gastroenterol 2017; 23:697-702. [PMID: 28216977 PMCID: PMC5292344 DOI: 10.3748/wjg.v23.i4.697] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 11/27/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.
METHODS Small-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the Lombardy Registry from October 2011 to December 2013, were included in the study if the clinical indication was obscure gastrointestinal bleeding and the capsule reached the cecum. Based on capsule findings, we created two groups: P2 (significant findings) and P0-1 (normal/negligible findings). Groups were compared for age, gender, small-bowel transit time, type of instrument, modality of capsule performance (outpatients vs inpatients), bowel cleanliness, and center volume.
RESULTS We retrieved and scrutinized 1,433 out of 2,295 capsule endoscopy records (62.4%) fulfilling the inclusion criteria. Patients were 67 ± 15 years old, and 815 (57%) were males. In comparison with patients in the P0-1 group, those in the P2 group (n = 776, 54%) were older (P < 0.0001), had a longer small-bowel transit time (P = 0.0015), and were more frequently examined in low-volume centers (P < 0.001). Age and small-bowel transit time were correlated (P < 0.001), with age as the sole independent predictor on multivariable analysis. Findings of the P2 group were artero-venous malformations (54.5%), inflammatory (23.6%) and protruding (10.4%) lesions, and luminal blood (11.5%).
CONCLUSION In this selected, prospectively collected cohort of small-bowel capsule endoscopy performed for obscure gastrointestinal bleeding, a longer small-bowel transit time was associated with a higher detection rate of significant lesions, along with age and a low center volume, with age serving as an independent predictor.
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Abstract
BACKGROUND Small bowel (SB) capsule endoscopy (CE) studies provide data on both gastric and SB transit times (GTT and SBTT, respectively). AIMS This study aimed to evaluate the influence of demographic and clinical parameters on the GTT and SBTT. Transit times for two generations of capsules (Pillcam SB2 and SB3) were also compared. METHODS Consecutive adult patients undergoing CE were included. GTT, SBTT, and cecum arrival rates were calculated and correlated to demographics and clinical characteristics. RESULTS A total of 332 CE studies were analyzed. Neither GTT nor SBTT were impacted by age or sex. SBTT was prolonged in newly diagnosed Crohn's disease (CD) patients compared with all other patients (303.1±90.3 vs. 243.6±83.6 min, P=0.02 for SB2, 267.8±63 vs. 228.6±72.3, P=0.01 for SB3, respectively). Moreover, CD patients had higher incomplete study rates compared with patients with all other diagnoses (29.4 vs. 7.3%, respectively, P=0.0116) in the SB2 subgroup. Higher cecum arrival rates were achieved by the SB3 capsule compared with SB2 (97 vs. 91%, P=0.04). Patients with prolonged gastric time or patients with incomplete studies had similar demographic and clinical characteristics as others. CONCLUSION Age and sex apparently do not influence intestinal kinetics. Newly diagnosed CD patients have relatively prolonged SBTTs. Demographic and clinical parameters cannot predict prolonged GTT or cecum nonarrival.
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Rayner-Hartley E, Alsahafi M, Cramer P, Chatur N, Donnellan F. Low volume polyethylene glycol with ascorbic acid, sodium picosulfate-magnesium citrate, and clear liquid diet alone prior to small bowel capsule endoscopy. World J Gastrointest Endosc 2016; 8:433-438. [PMID: 27298715 PMCID: PMC4896905 DOI: 10.4253/wjge.v8.i11.433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/10/2016] [Accepted: 02/24/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare low volume polyethylene glycol with ascorbic acid, sodium picosulfate-magnesium citrate and clear liquid diet alone as bowel preparation prior to small bowel capsule endoscopy (CE).
METHODS: We retrospectively collected all CE studies done from December 2011 to July 2013 at a single institution. CE studies were reviewed only if low volume polyethylene glycol with ascorbic acid, sodium picosulfate-magnesium citrate or clear liquid diet alone used as the bowel preparation. The studies were then reviewed by the CE readers who were blinded to the preparation type. Cleanliness and bubble burden were graded independently within the proximal, middle and distal small bowel using a four-point scale according to the percentage of small bowel mucosa free of debris/bubbles: grade 1 = over 90%, grade 2 = between 90%-75%, grade 3 = between 50%-75%, grade 4 = less than 50%. Data are expressed as mean ± SEM. ANOVA and Fishers exact test were used where appropriate. P values < 0.05 were considered statistically significant.
RESULTS: A of total of 123 CE studies were reviewed. Twenty-six studies were excluded from analysis because of incomplete small bowel examination. In the remaining studies, 39 patients took low volume polyethylene glycol with ascorbic acid, 31 took sodium picosulfate-magnesium citrate and 27 took a clear liquid diet alone after lunch on the day before CE, followed by overnight fasting in all groups. There was no significant difference in small bowel cleanliness (1.98 ± 0.09 vs 1.84 ± 0.08 vs 1.76 ± 0.08) or small bowel transit time (213 ± 13 vs 248 ± 14 ± 225 ± 19 min) for clear liquid diet alone, MoviPrep and Pico-Salax respectively. The bubble burden in the mid small bowel was significantly higher in the MoviPrep group (1.6 ± 0.1 vs 1.9 ± 0.1 vs 1.6 ± 0.1, P < 0.05). However this did not result in a significant difference in diagnosis of pathology.
CONCLUSION: There was no significant difference in small bowel cleanliness or diagnostic yield of small bowel CE between the three preparations regimens used in this study.
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Optimal Bowel Preparation for Video Capsule Endoscopy. Gastroenterol Res Pract 2015; 2016:6802810. [PMID: 26880894 PMCID: PMC4736012 DOI: 10.1155/2016/6802810] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/22/2015] [Indexed: 12/19/2022] Open
Abstract
During video capsule endoscopy (VCE), several factors, such as air bubbles, food material in the small bowel, and delayed gastric and small bowel transit time, influence diagnostic yield, small bowel visualization quality, and cecal completion rate. Therefore, bowel preparation before VCE is as essential as bowel preparation before colonoscopy. To date, there have been many comparative studies, consensus, and guidelines regarding different kinds of bowel cleansing agents in bowel preparation for small bowel VCE. Presently, polyethylene glycol- (PEG-) based regimens are given primary recommendation. Sodium picosulphate-based regimens are secondarily recommended, as their cleansing efficacy is less than that of PEG-based regimens. Sodium phosphate as well as complementary simethicone and prokinetics use are considered. In this paper, we reviewed previous studies regarding bowel preparation for small bowel VCE and suggested optimal bowel preparation of VCE.
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Flass T, Tong S, Frank DN, Wagner BD, Robertson CE, Kotter CV, Sokol RJ, Zemanick E, Accurso F, Hoffenberg EJ, Narkewicz MR. Intestinal lesions are associated with altered intestinal microbiome and are more frequent in children and young adults with cystic fibrosis and cirrhosis. PLoS One 2015; 10:e0116967. [PMID: 25658710 PMCID: PMC4319904 DOI: 10.1371/journal.pone.0116967] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/17/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Cirrhosis (CIR) occurs in 5-7% of cystic fibrosis (CF) patients. We hypothesized that alterations in intestinal function in CF contribute to the development of CIR. AIMS Determine the frequency of macroscopic intestinal lesions, intestinal inflammation, intestinal permeability and characterize fecal microbiome in CF CIR subjects and CF subjects with no liver disease (CFnoLIV). METHODS 11 subjects with CFCIR (6 M, 12.8 yrs ± 3.8) and 19 matched with CFnoLIV (10 M, 12.6 yrs ± 3.4) underwent small bowel capsule endoscopy, intestinal permeability testing by urinary lactulose: mannitol excretion ratio, fecal calprotectin determination and fecal microbiome characterization. RESULTS CFCIR and CFnoLIV did not differ in key demographics or CF complications. CFCIR had higher GGT (59±51 U/L vs 17±4 p = 0.02) and lower platelet count (187±126 vs 283±60 p = 0.04) and weight (-0.86 ± 1.0 vs 0.30 ± 0.9 p = 0.002) z scores. CFCIR had more severe intestinal mucosal lesions on capsule endoscopy (score ≥4, 4/11 vs 0/19 p = 0.01). Fecal calprotectin was similar between CFCIR and CFnoLIV (166 μg/g ±175 vs 136 ± 193 p = 0.58, nl <120). Lactulose:mannitol ratio was elevated in 27/28 subjects and was slightly lower in CFCIR vs CFnoLIV (0.08±0.02 vs 0.11±0.05, p = 0.04, nl ≤0.03). Small bowel transit time was longer in CFCIR vs CFnoLIV (195±42 min vs 167±68 p<0.001, nl 274 ± 41). Bacteroides were decreased in relative abundance in CFCIR and were associated with lower capsule endoscopy score whereas Clostridium were more abundant in CFCIR and associated with higher capsule endoscopy score. CONCLUSIONS CFCIR is associated with increased intestinal mucosal lesions, slower small bowel transit time and alterations in fecal microbiome. Abnormal intestinal permeability and elevated fecal calprotectin are common in all CF subjects. Disturbances in intestinal function in CF combined with changes in the microbiome may contribute to the development of hepatic fibrosis and intestinal lesions.
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Affiliation(s)
- Thomas Flass
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, United States of America
| | - Suhong Tong
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital, Aurora, Colorado, United States of America
| | - Daniel N. Frank
- Department of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Brandie D. Wagner
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital, Aurora, Colorado, United States of America
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, United States of America
| | - Charles E. Robertson
- Department of Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - Cassandra Vogel Kotter
- Department of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Ronald J. Sokol
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, United States of America
- Colorado Clinical and Translational Sciences Institute, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Edith Zemanick
- Section of Pediatric Pulmonary Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, United States of America
| | - Frank Accurso
- Section of Pediatric Pulmonary Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, United States of America
| | - Edward J. Hoffenberg
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, United States of America
| | - Michael R. Narkewicz
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, United States of America
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Niv E, Fishman S, Kachman H, Arnon R, Dotan I. Sequential capsule endoscopy of the small bowel for follow-up of patients with known Crohn's disease. J Crohns Colitis 2014; 8:1616-23. [PMID: 24666976 DOI: 10.1016/j.crohns.2014.03.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 02/25/2014] [Accepted: 03/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to perform sequential small bowel (SB) capsule endoscopy (CE) studies in patients with known active Crohn's disease (CD) during different treatments, to characterize the changes in the SB mucosa over time, and to correlate the CE findings with clinical and laboratory parameters of inflammation. METHODS Consecutive patients with known moderately active CD were prospectively recruited. After proven patency with Agile capsule, CE studies were performed at baseline and after 4, 12 and 24 weeks. CE parameters and a Lewis score were calculated. Clinical and laboratory parameters were correlated. A control group of 178 non-CD patients was used for comparisons. RESULTS Thirty-one CD patients were recruited and 19 met the inclusion criteria. A total of 43 CE studies were performed over the time. There was no capsule retention despite a high rate of previous SB surgery. The mean baseline CDAI, IBDQ and Lewis scores were 306±56, 135±26.6 and 1730±1780, respectively. There was no correlation at the baseline between clinical and laboratory parameters (CDAI, CRP, IBDQ) and mucosal disease (Lewis scores). CDAI and IBDQ changes over a period of 4 and 12 weeks did not correlate with the Lewis score. The cecum arrival rate of the CD patients was significantly lower (p=0.0047) and the SB transit time was significantly longer (p=0.005) compared to those of the controls. CONCLUSIONS Sequential CE studies are feasible and safe in CD patients. In patients with complete CE studies, they provide reliable information on mucosal changes in CD and should be considered as an independent and objective follow-up tool in known CD patients.
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Affiliation(s)
- Eva Niv
- IBD Center, The Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel(1).
| | - Sigal Fishman
- IBD Center, The Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel(1)
| | - Helena Kachman
- IBD Center, The Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel(1)
| | - Ruth Arnon
- Department of Immunology, Weizmann Institute of Science, Tel-Aviv, Israel
| | - Iris Dotan
- IBD Center, The Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel(1)
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Westerhof J, Weersma RK, Hoedemaker RA, Koornstra JJ. Completion rate of small bowel capsule endoscopy is higher after erythromycin compared to domperidone. BMC Gastroenterol 2014; 14:162. [PMID: 25234278 PMCID: PMC4177765 DOI: 10.1186/1471-230x-14-162] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/16/2014] [Indexed: 12/15/2022] Open
Abstract
Background In up to 30 percent of small bowel capsule endoscopy procedures, the capsule does not reach the cecum within recording time. A prolonged gastric transit time has been recognized as a risk factor for incomplete capsule endoscopy. The aim of this study was to analyze if a single dose of orally administered erythromycin prior to capsule endoscopy results in a higher completion rate compared to orally administered domperidone. Methods Single centre, non-concurrent prospective cohort study, 649 capsule endoscopy procedures were included. Cecal completion rates, gastric and small bowel transit times and diagnostic yield were analyzed. Results 239 patients received erythromycin, 410 patients received domperidone. The cecal completion rate was 86% after erythromycin versus 80% after domperidone (p = 0.03). After excluding known risk factors for incomplete capsule endoscopy such as hospitalization and previous abdominal surgery, erythromycin still resulted in an increased completion rate (p = 0.04). Median gastric transit time was lower after erythromycin compared to domperidone (13 min versus 22 min, p < 0.001). Median small bowel transit times were similar in both groups (236 min versus 248 min, p = 0.21). Conclusions In this study, the largest to date on this subject, the cecal completion rate was higher with erythromycin than with domperidone, but there was no difference in the diagnostic yield.
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Affiliation(s)
| | | | | | - Jan J Koornstra
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, PO Box 30001 9700 RB Groningen, The Netherlands.
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Ou G, Svarta S, Chan C, Galorport C, Qian H, Enns R. The effect of chewing gum on small-bowel transit time in capsule endoscopy: a prospective, randomized trial. Gastrointest Endosc 2014; 79:630-6. [PMID: 24112594 DOI: 10.1016/j.gie.2013.08.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/29/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Approximately 1 in 6 capsule endoscopies (CEs) does not visualize the entire small bowel at completion of the examination because of limited battery life. OBJECTIVE To determine whether chewing gum can reduce the small-bowel transit time and increase CE completion rates. DESIGN Prospective, single-blind, randomized, controlled trial. SETTING A tertiary university-affiliated hospital. PATIENTS Consecutive patients 19 years of age and older undergoing outpatient small-bowel CE from October 2010 to July 2012 were assessed for eligibility. Those with previous gastric or small-bowel surgery or ileostomy, dysphagia prohibiting capsule ingestion, diabetes mellitus with evidence of end-organ damage, use of narcotics or prokinetics within 5 days before the procedure, clinical hyper-/hypothyroidism, and symptoms suggestive of acute bowel obstruction were excluded. INTERVENTION Gum chewing for at least 20 minutes every 2 hours starting at the time of capsule ingestion. MAIN OUTCOME MEASUREMENTS Small-bowel transit time, gastric transit time, and completion rate were measured. RESULTS Chewing gum did not have any significant effect on gastric transit time (rate ratio 1.06; 95% CI, 0.73-1.55; P = .75), small-bowel transit time (rate ratio 0.91; 95% CI, 0.62-1.35; P = .65), or completion rate (91.67% chewing gum vs 88.71% control, P = .58) of CE. LIMITATION Single-center study involving relatively healthy subjects. Procedures were done on an outpatient basis so participants were not monitored for adherence to protocol. CONCLUSIONS Chewing gum does not speed up capsule transit or increase completion rate of CE in patients without risk factors for incomplete studies. ( CLINICAL TRIAL REGISTRATION NUMBER NCT01241825.).
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Affiliation(s)
- George Ou
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sigrid Svarta
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Calvin Chan
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cherry Galorport
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hong Qian
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Enns
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
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Koulaouzidis A, Giannakou A, Yung DE, Dabos KJ, Plevris JN. Do prokinetics influence the completion rate in small-bowel capsule endoscopy? A systematic review and meta-analysis. Curr Med Res Opin 2013; 29:1171-1185. [PMID: 23790243 DOI: 10.1185/03007995.2013.818532] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of purging for bowel cleansing prior to small-bowel capsule endoscopy (SBCE) has now been established in clinical practice. Despite that, the number of incomplete SBCEs is still around 15-20%. To date, the use of prokinetics in SBCE - aiming to improve completion rate (CR) - remains a contentious issue resulting in lack of consensus among capsule experts. METHODS Extensive medical literature searches were conducted (to November 2012), using suitable MeSH terms and keywords, in search of studies that compared capsule ingestion with prokinetic agents vs. controls or placebo. We examined the effects of prokinetic administration on SBCE CR (primary end point), as well as on the following secondary end points: diagnostic yield (DY), gastric transit time (GTT) and small-bowel transit time (SBTT) by meta-analysis of all relevant studies. RESULTS A total of 17 eligible studies (14 prospective, 3 retrospective) were identified, including 1028 individuals who ingested the capsule with no prokinetic vs. 876 who received a prokinetic. Overall, there was a higher CR in patients who ingested the capsule with prokinetics vs. controls (OR [95% CI]: 1.96 [1.38-2.78]). Of the two most readily available prokinetics, metoclopramide was associated with superior SBCE CR vs. control (OR [95% CI]: 2.8 [1.35-3.21]), while erythromycin showed no benefit (OR [95% CI]: 1.36 [0.61-3.03]). Where prokinetics were used alone, neither metoclopramide nor erythromycin showed any benefit on CR. There was no benefit of prokinetics (over controls) on DY. However, metoclopramide had a significant effect on GTT and SBTT. LIMITATIONS The majority of the included studies were heterogeneous, and the effect of prokinetics on image quality and mucosal visualization was not examined. CONCLUSION Our pooled data shows that the use of prokinetics for capsule ingestion improves CR in SBCE. This effect appears to be particularly evident with metoclopramide, when used concurrently with purging and/or use of real-time monitoring. In a small number of studies, erythromycin showed - through its gastrokinetic effect - marginal benefit. No prokinetic has a beneficial effect on SBCE DY.
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Chandran S, Testro A, Urquhart P, La Nauze R, Ong S, Shelton E, Philpott H, Sood S, Vaughan R, Kemp W, Brown G, Froomes P. Risk stratification of upper GI bleeding with an esophageal capsule. Gastrointest Endosc 2013; 77:891-8. [PMID: 23453185 DOI: 10.1016/j.gie.2013.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 01/01/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Analysis of upper GI bleeding (UGIB) presentations to our institutions suggests that many patients admitted for endoscopic investigation could be managed safely as outpatients. OBJECTIVE To learn whether an esophageal capsule could identify a low-risk group of patients with UGIB who could safely wait for elective EGD. DESIGN Diagnostic, nonrandomized, single-blind (investigator) study. SETTING Three tertiary-care referral centers. PATIENTS Eighty-three consecutive adult patients referred for management of UGIB. INTERVENTION A capsule endoscopy (CE) was performed before EGD for the investigation and management of UGIB. MAIN OUTCOME MEASUREMENTS Detection rates of UGIB source and identification of a low-risk group of patients who would have been suitable for outpatient EGD based on CE findings. RESULTS In total, 62 of 83 patients (75%) had a cause for bleeding identified. Findings were concordant across both modalities in 34 patients (55%). Twenty-one patients (38%) with positive EGD results had negative CE results, 7 of whom were due to lack of duodenal visualization alone. However, 7 of 28 patients (25%) with normal EGD results had positive CE results. The subgroup of patients with duodenal visualization on CE, 23 of 25 (92%), were concordant with EGD for low-risk lesions that would have been suitable for outpatient management. LIMITATIONS Low duodenal visualization rates with CE and low concordance between EGD and CE. CONCLUSION Although CE is not currently ready to be used as a triage tool, when duodenal visualization was achieved CE correlated well with EGD findings and identified 92% of patients who may have been managed as outpatients.
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Affiliation(s)
- Sujievvan Chandran
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
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Song HJ, Moon JS, Do JH, Cha IH, Yang CH, Choi MG, Jeen YT, Kim HJ. Guidelines for Bowel Preparation before Video Capsule Endoscopy. Clin Endosc 2013; 46:147-54. [PMID: 23614124 PMCID: PMC3630308 DOI: 10.5946/ce.2013.46.2.147] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/24/2012] [Accepted: 04/24/2012] [Indexed: 12/12/2022] Open
Abstract
The preparation for video capsule endoscopy (VCE) of the bowel suggested by manufacturers of capsule endoscopy systems consists only of a clear liquid diet and an 8-hour fast. While there is evidence for a benefit from bowel preparation for VCE, so far there is no domestic consensus on the preparation regimen in Korea. Therefore, we performed this study to recommend guidelines for bowel preparation before VCE. The guidelines on VCE were developed by the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy. Four key questions were selected. According to our guidelines, bowel preparation with polyethylene glycol (PEG) solution enhances small bowel visualization quality (SBVQ) and diagnostic yield (DY), but it has no effect on cecal completion rate (CR). Bowel preparation with 2 L of PEG solution is similar to that with 4 L of PEG in terms of the SBVQ, DY, and CR of VCE. Bowel preparation with fasting or PEG solution combined with simethicone enhances the SBVQ, but it does not affect the CR of VCE. Bowel preparation with prokinetics does not enhance the SBVQ, DY, or CR of VCE.
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Affiliation(s)
- Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Matsunaga T, Hashimoto S, Okamoto T, Harima S, Tanabe R, Nishikawa J, Sakaida I. Effect of capsule placement with transnasal endoscopy. Dig Endosc 2013; 25:156-9. [PMID: 23368535 DOI: 10.1111/j.1443-1661.2012.01346.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM One of the prohibiting factors in achieving complete small bowel capsule endoscopy is slow gastric transit of the capsule. The present study retrospectively investigated the success rate of, and the time required for, transnasal endoscope-assisted capsule placement to assess its clinical utility. METHODS In 24 of 27 patients who underwent capsule placement assisted by a transnasal endoscope, the capsule was successfully transported to and released in the duodenum (capsule placement group). For each patient in the capsule placement group, three age- and sex-matched patients who underwent conventional capsule endoscopy were assigned as controls (n=72). Gastric transit time, small bowel transit time, and rate of capsule arrival at the cecum within 8h were compared between the two patient groups. RESULTS Among the 27 patients in whom capsule placement was carried out, the capsule was successfully placed in the duodenum in 24 patients (88.9% success rate). In the capsule placement group, gastric transit time was significantly shorter (10.5 vs 46.2min, P=0.0021), small bowel transit time was significantly longer (354.7 vs 301.3min, P=0.0134), and completion rate (capsule arrival at the cecum within 8h) was significantly higher (83.3 vs 61.1%, P=0.0455) than in the control group. There were no procedural accidents associated with capsule placement. CONCLUSION Transnasal endoscope-assisted capsule placement appears to be a safe and reliable procedure, achieving complete small bowel capsule endoscopy, and is considered clinically useful.
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Affiliation(s)
- Takaharu Matsunaga
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Niv E, Ovadia B, Ron Y, Santo E, Mahajna E, Halpern Z, Fireman Z. Ensure preparation and capsule endoscopy: A two-center prospective study. World J Gastroenterol 2013; 19:1264-70. [PMID: 23483023 PMCID: PMC3587483 DOI: 10.3748/wjg.v19.i8.1264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 02/10/2012] [Accepted: 03/10/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare small bowel (SB) cleanliness and capsule endoscopy (CE) image quality following Ensure®, polyethylene glycol (PEG) and standard preparations.
METHODS: A preparation protocol for CE that is both efficacious and acceptable to patients remains elusive. Considering the physiological function of the SB as a site for the digestion and absorption of food and not as a stool reservoir, preparation consisting of a liquid, fiber-free formula ingested one day before a CE study might have an advantage over other kinds of preparations. We conducted a prospective, blind-to-preparation, two-center study that compared four types of preparations. The participants’ demographic and clinical data were collected. Gastric and SB transit times were calculated. The presence of bile in the duodenum was scored by a single, blinded-to-preparation gastroenterologist expert in CE, as was cleanliness within the proximal, middle and distal part of the SB. A four-point scale was used (grade 1 = no bile or residue, grade 4 ≥ 90% of lumen full of bile or residual material).
RESULTS: The 198 consecutive patients who were referred to CE studies due to routine medical reasons were divided into four groups. They all observed a 12-h overnight fast before undergoing CE. Throughout the 24 h preceding the fast, control group 1 (n = 45 patients) ate light unrestricted meals, control group 2 (n = 81) also ate light meals but free of fruits and vegetables, the PEG group (n = 50) ate unrestricted light meals and ingested the PEG preparation, and the Ensure group (n = 22) ingested only the Ensure formula. Preparation with Ensure improved the visualization of duodenal mucosa (a score of 1.76) by decreasing the bile content compared to preparation with PEG (a score of 2.9) (P = 0.053). Overall, as expected, there was less residue and stool in the proximal part of the SB than in the middle and distal parts in all groups. The total score of cleanliness throughout the length of the SB showed some benefit for Ensure (a score of 1.8) over control group 2 (a score of 2) (P = 0.06). The cleanliness grading of the proximal and distal parts of the SB was similar in all four groups (P = 0.6 for both). The cleanliness in the middle part of the SB in the PEG (a score of 1.8) and Ensure groups (a score of 1.7) was equally better than that of control group 2 (a score of 2.1) (P = 0.057 and P = 0.07, respectively). All 50 PEG patients had diarrhea as an anticipated side effect, compared with only one patient in the Ensure group.
CONCLUSION: Preparation with Ensure, a liquid, fiber-free formula has advantages over standard and PEG preparations, with significantly fewer side effects than PEG.
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Gibbs WB, Bloomfeld RS. Endoscopic deployment of video capsule endoscopy: does it guarantee a complete examination of the small bowel? Gastrointest Endosc 2012; 76:905-9. [PMID: 22854059 DOI: 10.1016/j.gie.2012.05.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 05/29/2012] [Indexed: 02/08/2023]
Affiliation(s)
- Wood B Gibbs
- Section of Gastroenterology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Xiong GY, Wang M, Yang LH, You SH. Relationship between gastric transit time and complete examination rate of the capsule endoscopy examinations. Shijie Huaren Xiaohua Zazhi 2012; 20:2318-2321. [DOI: 10.11569/wcjd.v20.i24.2318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the right timing for intervention when capsule endoscope transits for a relatively long time in the stomach.
METHODS: The following items were analyzed in 109 patients who underwent capsule endoscopy (CE) examinations: the relationship between gastric transit time (GTT) and complete examination rate (CER); the correlation between GTT and small bowel transit time (SBTT); the difference in GTT between groups of complete and incomplete examinations; and the risk of incomplete examination in patients with strictures of the small intestine.
RESULTS: No difference was found in CER among groups with GTT ≤ 30 min, 30-60 min, 60-90 min, or > 90 min (P = 0.971). Injection of metoclopramide in patients with longer GTT resulted in shorter SBTT compared to their counterparts with shorter GTT (t = -2.027, P = 0.046). No difference was found in GTT between groups of complete and incomplete examinations [45.6 min ± 35.8 min (n = 85) vs 42.0 min ± 36.4 min (n = 24), P = 0.665]. The risk of incomplete examination in patients with strictures of the small intestine was 6.588-fold higher than those without strictures (OR = 6.588, 95% CI = 1.866-23.258, P = 0.004).
CONCLUSION: Too early delivery of capsule endoscope in the duodenum might not improve CER. This procedure should be considered only if the retention of CE in the stomach exceeds 90 min, and it is better to be completed within 30 min.
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Ida Y, Hosoe N, Imaeda H, Bessho R, Ichikawa R, Naganuma M, Kanai T, Hibi T, Ogata H. Effects of the oral administration of mosapride citrate on capsule endoscopy completion rate. Gut Liver 2012; 6:339-343. [PMID: 22844562 PMCID: PMC3404171 DOI: 10.5009/gnl.2012.6.3.339] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 12/04/2011] [Accepted: 12/19/2011] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/AIMS In capsule endoscopy (CE), the capsule does not always reach the cecum within its battery life, which may reduce its diagnostic yield. We evaluated the effect of mosapride citrate, a 5-hydroxytryptamine-4 agonist that increases gastrointestinal motility, on CE completion. METHODS In a retrospective study, we performed univariate and multivariate analyses for 232 CE procedures performed at our hospital. To identify factors that affect CE completion, the following data were systematically collected: gender, age, gastric transit time (GTT), nonsteroidal anti-inflammatory drug administration, previous abdominal surgery, hospitalization, use of a polyethylene glycol solution, use of mosapride citrate (10 mg), body mass index (BMI), and total recording time. RESULTS The univariate analysis showed that oral mosapride citrate, GTT, and BMI were associated with improved CE completion. Multivariate analyses showed that oral mosapride citrate (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.01 to 3.91) and GTT (OR, 2.34; 95% CI, 1.13 to 4.87) were significant factors for improving the CE completion. Oral mosapride citrate significantly shortened the GTT and small bowel transit time (SBTT). CONCLUSIONS Oral mosapride citrate reduced the GTT and SBTT during CE and improved the CE completion rate.
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Affiliation(s)
- Yosuke Ida
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Hosoe
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Imaeda
- Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Rieko Bessho
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Riko Ichikawa
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Naganuma
- Department of Gastroenterology, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Toshifumi Hibi
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
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Ito T, Ohata K, Ono A, Chiba H, Tsuji Y, Sato H, Matsuhashi N. Prospective controlled study on the effects of polyethylene glycol in capsule endoscopy. World J Gastroenterol 2012; 18:1789-1792. [PMID: 22553403 PMCID: PMC3332292 DOI: 10.3748/wjg.v18.i15.1789] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 09/14/2011] [Accepted: 02/26/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To prospectively confirm whether a small amount of polyethylene glycol (PEG) ingested after swallowing endoscopy capsule improves image quality and completion rate. METHODS Forty-four consecutive patients referred to us for capsule endoscopy (CE) were randomized to two groups. All patients were restricted to clear fluids for 12 h before the examination. Patients in group A (22 cases) received no additional preparation, while those in group B (20 cases) ingested 500 mL of PEG within a 2 h period starting 30 min after swallowing the capsule. Clear fluids and meals were allowed 2 h and 4 h after capsule ingestion, respectively. Image quality was assessed as the percentage of visualized bowel surface area as follows: 1: < 25%; 2: 25%-49%; 3: 50%-74%; 4: 75%-89%; 5: > 90%. The small bowel record was divided into five segments by time, and the score for each segment was evaluated. All CE examinations were performed with the Pillcam SB capsule endoscopy system (Given Imaging Co. Ltd., Yoqnem). RESULTS This study ended in December 2009, because sample size was considered large enough. A total of 44 patients were enrolled. Two patients in group B were excluded from the analysis because small bowel images could not be obtained from these patients; one had a full stomach, while the other presented with a massive gastric bleed. Thus, 22 patients from group A and 20 patients from group B completed the study. There was no significant difference in age (P = 0.22), sex (P = 0.31), and indication for CE. No significant adverse events occurred in any of the study patients. In group A, image quality deteriorated as the capsule progressed distally. However, in group B, image quality was maintained to the distal small bowel. In each of the five segments, the visibility score was significantly higher in group B than in group A (segment 1: 4.3 ± 0.7 vs 4.7 ± 0.5, P = 0.03; segment 2: 4.2 ± 0.9 vs 4.8 ± 0.4, P = 0.01; segment 3: 4.0 ± 1.0 vs 4.6 ± 0.7, P = 0.04; segment 4: 3.6 ± 1.1 vs 4.5 ± 0.6, P = 0.003; segment 5: 2.7 ± 1.0 vs 4.4 ± 0.8, P = 0.00004). Thus, the use of PEG during CE examination significantly improved image quality in all time segments, and this effect was more pronounced in the distal ileum. The completion rate to the cecum was not significantly different between groups A and B (81.8% vs 85.0%, P = 0.89). There was no difference in the gastric transit time between groups (36.2 ± 35.0 min vs 54.0 ± 56.6 min, P = 0.23), but the small bowel transit time was significantly longer in group A than in group B (246.0 ± 107.0 min vs 171.0 ± 104.0 min, P = 0.04). CONCLUSION The ingestion of a small amount of PEG after the swallowing of an endoscopy capsule significantly improved CE image quality, but did not enhance the completion rate to the cecum.
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Westerhof J, Koornstra JJ, Hoedemaker RA, Sluiter WJ, Kleibeuker JH, Weersma RK. Diagnostic yield of small bowel capsule endoscopy depends on the small bowel transit time. World J Gastroenterol 2012; 18:1502-7. [PMID: 22509082 PMCID: PMC3319946 DOI: 10.3748/wjg.v18.i13.1502] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 07/13/2011] [Accepted: 02/27/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether the small bowel transit time (SBTT) influences the diagnostic yield of capsule endoscopy (CE).
METHODS: Six hundred and ninety-one consecutive CE procedures collected in a database were analyzed. SBTT and CE findings were recorded. A running mean for the SBTT was calculated and correlated to the diagnostic yield with a Spearman’s correlation test. Subgroup analyses were performed for the various indications for the procedure.
RESULTS: There was a positive correlation between the diagnostic yield and SBTT (Spearman’s rho 0.58, P < 0.01). Positive correlations between diagnostic yield and SBTT were found for the indication obscure gastrointestinal bleeding (r = 0.54, P < 0.01), for polyposis and carcinoid combined (r = 0.56, P < 0.01) and for the other indications (r = 0.90, P <0.01), but not for suspected Crohn’s disease (r = -0.40).
CONCLUSION: The diagnostic yield in small bowel capsule endoscopy is positively correlated with the small bowel transit time. This is true for all indications except for suspected Crohn’s disease.
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González Suárez B, Dedeu Cuscó JM, Galter Copa S, Mata Bilbao A. Cápsula endoscópica: documento de posicionamiento de la Sociedad Catalana de Digestología. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:573-83. [DOI: 10.1016/j.gastrohep.2011.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 05/02/2011] [Indexed: 12/15/2022]
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Shiotani A, Honda K, Kawakami M, Nishi R, Murao T, Ishii M, Matsumoto H, Kusunoki H, Hata J, Haruma K. Use of an external real-time image viewer coupled with prespecified actions enhanced the complete examinations for capsule endoscopy. J Gastroenterol Hepatol 2011; 26:1270-4. [PMID: 21443670 DOI: 10.1111/j.1440-1746.2011.06734.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM The clinical utility of capsule endoscopy (CE) is often limited by incomplete small-bowel transit. The aim was to determine whether the use of an external real-time viewer could reduce delays caused by delayed gastric emptying of the capsule or delayed intestinal transit and also improve the rate of positive findings. METHODS We compared the proportion of completed exams and positive results among a group of patients studied before introduction of real-time viewer and a group in which capsule transit through the esophagus, stomach, and small bowel was regularly monitored and actions (e.g. administration of water or intravenous metoclopramide) were taken if it was delayed. RESULTS One hundred procedures in the viewer group and 100 control procedures in the age-matched controls were analyzed. In the viewer group, additional water intake (22 cases) and/or administration of metoclopramide (26 cases) were required. Endoscopic-assisted duodenal placement of the capsule was required in three cases. Overall one-third (n=33) of cases required viewer-prompted interventions. The completion rate (86% vs 66%, P=0.002) and the rate of positive findings (80% vs 67%, P=0.04) were significantly higher in the viewer group compared to the no viewer group. CONCLUSIONS Checking the progress of the capsule with the external real-time viewer improved the diagnostic yield and completion rate of CE.
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Affiliation(s)
- Akiko Shiotani
- Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan.
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Yuan JH, Xin L, Liao Z, Li ZS. Advances in complete small-bowel examination by capsule endoscopy. Shijie Huaren Xiaohua Zazhi 2010; 18:3662-3666. [DOI: 10.11569/wcjd.v18.i34.3662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Capsule endoscopy (CE) has a battery life of 8 h, during which time complete small-bowel examination can be achieved in most cases. However, in 10-30% of cases, the capsule cannot reach the ileocecal valve before the end of the life of the capsule's battery due to factors other than mechanical bowel obstruction. Incomplete examination of the entire small bowel leaves room for missing lesions. Some studies have shown that diabetes mellitus can lead to gastroparesis and increase gastric transit time (GTT), while history of abdominal surgery can increase small bowel transit time (SBTT). Therefore, these two factors can decrease the rate of complete small-bowel examination by CE. Purgative bowel cleansing can improve the detectability and image quality of CE, but has no significant impact on GTT, SBTT and CR. Prokinetic drugs, real-time CE, right lateral position, and chewing-gum are all under research for increasing CR. In future studies, emphasis should be placed in improving the diagnostic ability of CR and ensuring optimal intervention for patients with high risk factors for incomplete small-bowel examination.
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Sidhu R, Drew K, Sanders DS, Sood R, McAlindon ME. Does the selective use of metoclopramide improve the completion rate of small-bowel capsule endoscopy? Gastrointest Endosc 2010; 72:670-1; author reply 671. [PMID: 20801296 DOI: 10.1016/j.gie.2009.12.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 12/29/2009] [Indexed: 02/08/2023]
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Gao YJ, Ge ZZ, Chen HY, Li XB, Dai J, Ye CA, Xiao SD. Endoscopic capsule placement improves the completion rate of small-bowel capsule endoscopy and increases diagnostic yield. Gastrointest Endosc 2010; 72:103-8. [PMID: 20304397 DOI: 10.1016/j.gie.2009.12.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 12/03/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND The methods for increasing the rate of complete small-bowel examinations by capsule endoscopy (CE) demonstrate conflicting results, and it is unknown whether improving the completion rate of CE transit is correlated with improvement in diagnostic yield. OBJECTIVE The aim of this study was to determine whether a higher rate of complete small-bowel examinations results in a higher diagnostic yield of CE. DESIGN Case-control comparison. SETTING Tertiary care university hospital. PATIENTS A total of 273 patients underwent conventional CE (group A), and 261 patients underwent real-time CE (group B). Furthermore, the patients in groups A and B were divided into 2 subgroups by pyloric transit time (A1, A2 and B1, B2, respectively). INTERVENTIONS After swallowing the capsule, each patient was monitored with a real-time viewer in group B, and the patients underwent endoscopic placement if the capsule was delayed in the esophagus or stomach. MAIN OUTCOME MEASUREMENTS Pyloric transit time, small-bowel transit time, the rate of complete small-bowel examinations, and the diagnostic yield. RESULTS The rate of complete small-bowel examinations was significantly higher in group B than in group A (87.4% vs 78.0%, respectively; P = .004). The diagnostic yield was significantly higher in group B2 than in group A2 (60.0% vs 41.7%, respectively; P = .019). LIMITATIONS Nonrandomized study. CONCLUSIONS Endoscopic placement improves the rate of complete small-bowel examinations, resulting in a higher diagnostic yield of CE.
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Affiliation(s)
- Yun Jie Gao
- Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, People's Republic of China
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Triantafyllou K. Can we improve the diagnostic yield of small bowel video-capsule endoscopy? World J Gastrointest Endosc 2010; 2:143-6. [PMID: 21160741 PMCID: PMC2999125 DOI: 10.4253/wjge.v2.i5.143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 03/15/2010] [Accepted: 03/22/2010] [Indexed: 02/05/2023] Open
Abstract
Video-capsule endoscopy has revolutionized the examination of small bowel mucosa. However, this modality is relatively young and its diagnostic yield is low. Herein, we discuss different approaches to improve examination’s diagnostic yield. There are strong data supporting some of them while there is speculation about the rest. As capsule endoscopy continues to evolve there is also a strong belief that technology will overcome at least some of the obstacles that hamper capsule endoscopy’s diagnostic yield sometime in the near future.
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Affiliation(s)
- Konstantinos Triantafyllou
- Konstantinos Triantafyllou, Hepatogastroenterology Unit, 2nd Department of Internal Medicine - Propaedeutic, Medical School, Athens University, "Attikon" University General Hospital, Haidari 12464, Greece
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Comparison of two schemes of small bowel preparation for capsule endoscopy with polyethylene glycol: a prospective, randomized single-blind study. Eur J Gastroenterol Hepatol 2009; 21:1140-4. [PMID: 19757514 DOI: 10.1097/meg.0b013e32832b2107] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Small bowel preparation for capsule endoscopy remains controversial. This study was conducted to compare the efficacy of 2 and 4 l of polyethylene glycol. METHODS One hundred and one patients (group A) received 2 l and 100 (group B) received 4 l in a prospective, randomized single-blind trial. To objectively evaluate enteric preparation, a cleansing coefficient was calculated for each patient. RESULTS The two groups were found comparable regarding age, sex, body mass index, and reason for referral. In 82 patients of group A and in 76 of group B, examination of small bowel was completed (P =0.40). Gastric emptying time and small bowel transit time were found comparable in both groups. Cleansing coefficients, for small bowel as a whole or for proximal or distal separately, were similar among the two groups. However, the cleansing coefficient of the proximal bowel was significantly higher than that of the distal, independently of preparation (group A: P < 0.001, group B: P< 0.001). Small bowel preparation was related only with the age of the patients and gastric emptying time; the younger the patient or the shorter the gastric emptying time, the higher the cleansing coefficient. Pathological findings were found in 43 (42.6%) patients of group A and in 37 (37.0%) patients of group B (P =0.42). A final positive diagnosis was established in 33 (32.7%) patients of group A and in 29 (29.0%) of group B (P = 0.57). CONCLUSION The two schemes were equal regarding enteric cleansing and completion of the procedure. Therefore, 2 l seems to be an adequate preparation for capsule endoscopy.
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