Effect of Erythromycin On Transit Time in Video Capsule Endoscopy: A Randomized Prospective Placebo Controlled Trial

Abstract

Purpose: Video Capsule Endoscopy (VCE) has revolutionized the field of small bowel imaging. However, the reported incompletion rate is high, ranging from 23-35%. The majority of incomplete exams are due to failure of the capsule to reach the cecum within the battery life of eight hours. Erythromycin, a motilin agonist, has been shown in previous studies to be effective in treatment of diabetic gastroparesis and reducing orocecal transit time. Several recent reports have revealed conflicting results in the use of erythromycin and improvement of completion rate for VCE. We conducted a randomized prospective placebo controlled trial in evaluating the effect of erythromycin in gastric and small bowel transit time in VCE. Method: 20 consecutive patients underwent VCE in ambulatory setting were randomly assigned into two groups. Patients were excluded if they were allergic to erythromycin, taking coumadin or digoxin, or pregnant. One group received erythromycin 250 mg orally an hour prior to VCE. The other group received placebo. All patients were prepped with 2L golytely 12 hours prior to VCE. The gastric, small bowel, and total transit time were recorded. Patients were requested to fill out a questionnaire immediately after VCE regarding symptoms of nausea, vomiting, and diarrhea, which were recorded in a scoring system (0-10) ranging from none to severe. Results: In the erythromycin group, gastric transit time was significantly shorter compared to the placebo group (mean of 12.1 min vs 37.0 min, p < 0.05). However, the small bowel transit time (262.5 min for erythromycin vs 244.7 min for placebo) and total transit time (274.6 min vs 281.7 min) were not significantly different between the two groups. All patients had completed exam with capsule reaching cecum in time. There was no significant difference in the symptom scores between the two groups. Conclusions: Erythromycin 250 mg orally one hour prior to VCE significantly decreased the gastric transit time, but had no significant effect on small bowel and total transit time. It was overall well tolerated. We therefore suggest a low threshold in the use of erythromycin prior to VCE in patients with risk factors for delayed gastric emptying.