Clinical Utility and Diagnostic Yield of 165 Wireless Capsule Studies at a Tertiary Referral Center

Abstract

Purpose: To determine the clinical utility and diagnostic yield of wireless motility capsule (WMC) (SmartPill®, Given Imaging, Yoqneam, Israel) in patients with suspected motility disorders of the gastrointestinal tract. Methods: A retrospective chart review of all patients who underwent WMC study from 2009-2012 using a standard protocol at the Cleveland Clinic was performed. Information regarding demographics, symptoms, medication use, past medical and surgical history, indications for WMC, WMC transit times and relevant diagnostic studies were retrieved. Results: A total of 165 subjects were included in the analysis. Mean age was 43 ± 16 years, and 83% were female. Subjects had a median of 4 tests done before undergoing WMC study, and 81% had at least one abnormal test. 78% of subjects had an abnormal WMC, including delayed large bowel transit time (LBTT) (39%), delayed gastric emptying time (GET) (35%) and delayed small bowel transit time (SBTT) (29%). There was no statistical difference in age, gender, symptoms, medication use, past medical or past surgical history between patients with normal vs. abnormal WMC study. In patients who were referred for WMC for evaluation of gastroparesis, small bowel transit time (SBTT) was delayed in 39%, and LBTT was delayed in 28%. Similarly, in patients who underwent WMC for evaluation of constipation, GET was delayed in 27%, and SBTT was delayed in 25%. 25% of patients suspected to have both gastroparesis and constipation had abnormal SBTT. A large number of patients with abnormal gastric emptying scintigraphy (GES) also had abnormal SBTT (36%) and LBTT (41%). Similarly, many patients with abnormal Sitzmarks Study also had delayed GET (50%) and delayed SBTT (15%). Conclusion: Our study indicates that a substantial number of patients with symptoms or motility studies suggestive of gastroparesis or constipation have more generalized gut dysmotility, which can be difficult to evaluate or detect without multiple motility testings. WMC provides a comprehensive regional evaluation of the GI tract transit. Whether the additional information obtained with the WMC influenced the management or outcome in our patient population is unclear and needs to be further investigated.Table