Clinical Utility of the RAPID Access RT for Real-Time Viewing of Capsule Endoscopy

Abstract

Introduction: The utility of capsule endoscopy (CE) is well established for the detection of small bowel disease. The current protocol allows the ingestion of liquids 2 hours and food 4 hours after ingestion of the PillCam SB, based on studies reporting an average gastric transit time of 1 hour. However, gastric transit times can be prolonged, resulting in contamination of luminal contents with food residue that can impair visibility. Aim: To evaluate the clinical utility of real-time viewing of capsule endoscopy images using the RAPID Access RT (Given Imaging) to determine if the PillCam SB had entered the small bowel. Material and Methods: During capsule endoscopy, real-time images were viewed at 60, 90 and 120 minutes to determine if the small bowel (SB) had been entered. If the capsule had reached the SB the patient's diet was immediately advanced to light meals. If the capsule was found to be retained in the stomach at 90 minutes, 10 mg of metoclopramide were administered to facilitate passage into the small bowel. If the capsule was found to be retained in the stomach at 120 minutes, the patient was referred for endoscopic SB placement of the capsule. Results: 20 patients (8M/12F; mean age 55) were studied. RAPID Access RT acquisition of real-time images was successful in all patients. The image quality was found to be excellent. The capsule had reached the SB after 60 minutes in 11 patients. The time to reach the cecum was less than 4 hours in 8 patients (40%) and less than 6 hours in an additional 5 patients (65%). The capsule remained in the stomach after 120 minutes in 3 patients who were then referred for endoscopy-assisted placement in the SB. In 2 patients the capsule passed spontaneously into the SB before upper endoscopy could be performed. The third patient refused to undergo upper endoscopy. The capsule reached the cecum in only one of the three patients with delayed gastric passage. Conclusions: The RAPID Access RT system enabled real-time viewing of CE images in all patients. Oral intake was appropriately started after the capsule reached the small bowel. Documentation of passage into the SB at 60 minutes allowed early advancement of oral intake. This may have particular utility in patients requiring medication. Documentation of delayed gastric passage at 90 and 120 minutes allowed the institution of measures to facilitate capsule passage into the small bowel.