Abstract
Background/Aim: Chewing gum throughout small bowel capsule endoscopy (SBCE) increases completion rates (CRs) but decreases small bowel transit time (SBTT) and diagnostic yield (DY). We determined the effects of chewing gum early during SBCE on gastric transit time (GTT), SBTT, CR, DY, and gastroscopy intervention.Methods: We prospectively enrolled patients (ages 16–80 years) undergoing SBCE between January and June 2019. Patients were randomized to a chewing gum group (103 patients) and a control group (102 patients). Patients in the former group chewed one piece of gum for ~15 min every 30 min during the first hour of SBCE. Two gastroenterologists blinded to the study group examined the data.Results: GTT was shorter in the chewing gum group (29.0 min, interquartile range: 17.0–52.0 min) than in the control group [42.5 min (23.25–60 min); P = 0.01]. SBTT was similar in the two groups [318.5 min (239.5–421.3 min) vs. 287.0 min (216.0–386.0 min); P = 0.08]. Gastroscopy rate was lower in the chewing gum group (15.53 vs. 32.35%, P = 0.005). CR (95.15 vs. 89.22%, P = 0.114) and DY (67.96 vs. 59.80%, P = 0.224) did not differ between the groups. The number of abnormal-lesion types detected per patient was higher in the chewing gum group [1.0 (0.0–2.0) vs. 2.0 (0.0–2.0); P = 0.049].Conclusions: Chewing gum early during SBCE significantly reduced GTT and gastroscopy intervention, with no influence on SBTT (Trial number: NCT03815136).
Highlights
Small bowel capsule endoscopy (SBCE) has greatly facilitated the screening, diagnosis, and monitoring of small bowel diseases [1, 2]
gastric transit time (GTT) was shorter in the chewing gum group (19.0 min, interquartile range: 17.0–52.0 min) than in the control group [42.5 min (23.25–60 min); P = 0.01]
Gastroscopy rate was lower in the chewing gum group (15.53 vs. 32.35%, P = 0.005)
Summary
Small bowel capsule endoscopy (SBCE) has greatly facilitated the screening, diagnosis, and monitoring of small bowel diseases [1, 2]. SBCE has been shown to be efficacious for conditions such as celiac disease, iron-deficiency anemia, small bowel tumors, and familial polyposis syndromes [3]. It is especially useful as a first-line investigation for obscure gastrointestinal bleeding [4]. A gastric transit time (GTT) >45 min has been shown to be an independent risk factor for incomplete SBCE [7], while the DY of SBCE has been reported to be positively correlated with small bowel transit time (SBTT) [8]. Gastric or esophageal retention of the capsule can prevent the endoscope from crossing the pylorus, prolonging GTT and even leading to a failure to reach the cecum within the available recording time. The endoscopic placement of the capsule can be used to overcome this problem, this method increases patients’ economic burden and discomfort [9]
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