Clinical Impact of a Newly-Developed Capsule Endoscope: Usefulness of a Real Time Image Viewer Against Gastrointestinal Transit Abnormality

Abstract

Background and Aim: We have developed a new capsule endoscope in collaboration with Olympus Medical Systems Co, Japan, and analyzed the clinical usefulness of a real time image viewer against gastrointestinal transit abnormality. Methods: By using this new device, a clinical trial for evaluation of the small bowel has been ongoing in our institute, and all patients will be enrolled until the end of January, 2006. Up to date 42 patients have been enrolled to this study, and 32 consecutive patients (18 men, 14 women mean age 54 years, range 29-80 years) underwent the capsule endoscopy. In case of gastric transit abnormality (taking more than 60 minutes for gastric transit detected by the image viewer), intramuscular administration of metoclopramide (10 mg) was performed to the patient. Diagnostic yield, gastric and small bowel transit time in patients with/without metoclopramide administration group were analyzed. Results: This new capsule provided excellent visualization of the precise construction of small intestinal villi, in some cases even a small-sized-erosion was found which was hardly detected by Barium X-ray. Overall diagnostic yield was 75% (24/32 patients), and there was no significant difference in the ratio of abnormal findings documented between the groups with/without metoclopramide administration. Although mean gastric transit time was significantly longer in the group with metoclopramide administration than the group without administration (105 minutes vs. 30 minutes; p = 0.005), mean small bowel transit time was conversely shorter in the administration group than the group without administration (288 minutes vs. 338 minutes; p = 0.06). Further, small bowel transit was complete in 8/10 patients (80%) in the administration group, and in 18/22 patients (82%) in the group without administration, and there was no significant difference. Conclusions: This new technology allowed for clear real time image interpretation on an LCD display, and could be useful for detecting the gastric transit abnormality as well as for increasing the likelihood of a complete small-bowel examination in patients undergoing capsule endoscopy.