Greater Impact of Wireless Motility Capsule Testing versus Gastric Emptying Scintigraphy on Clinical Decision Making in Patients With Suspected Gastroparesis: A Prospective, Multicenter Evaluation: 2017 Category Award (Stomach): 2017 Presidential Poster Award

Abstract

Introduction: Gastric emptying scintigraphy (GES) is used to diagnose gastroparesis, but its impact on clinical decision making is undefined. The Wireless Motility Capsule (WMC) is approved to quantify gastric emptying and also measures small bowel and colon transit in suspected gastroparesis. Retrospective reports suggest WMC findings change patient management. In this prospective study of concurrent GES and WMC testing, we hypothesized that WMC tests more often promote management changes and eliminate additional test requests vs. GES in suspected gastroparesis. Methods: Management plans were completed for 150 patients with >2 gastroparesis symptoms (nausea, vomiting, early satiety, bloating, fullness) x >12 wk at 10 academic and community centers in a prospective simultaneous GES and WMC study. Based on test results, site investigators devised 3 management plans to change medication and diet therapies, place surgery referrals, and order additional diagnostic tests. The 1st plan was based on results of 1 test (GES or WMC in random order) with blinding to the other test; the 2nd plan was based on the 2nd test without blinding to the 1st; the 3rd plan was based on both tests. The influence of both tests on management plans was compared. Results: WMCs found gastric emptying delays more often than GES (35% vs. 24%, P=0.005) and small bowel and colon delays in 23% and 32%. Therapy changes (prokinetics, neuromodulators, laxatives) were advocated for 111 patients (74%); they were more often based on WMC vs. GES (68% vs. 48%, P < 0.0001) and were recommended in 26% when only WMC was abnormal vs. 6% when only GES was abnormal (P < 0.0001) showing greater impact of WMCs on clinical decisions. Diet changes and surgery were recommended similarly for both tests. WMCs eliminated needs for additional diagnostic tests (endoscopy, radiography, other motility tests) in 71% vs. 31% for GES (P < 0.0001). Eliminating additional tests was advised more often when only WMC vs. GES was abnormal (45% vs. 5%)(P < 0.0001). Conclusion: WMC testing has higher sensitivity for detecting gastroparesis vs. GES and provides an additional diagnostic yield by profiling the full GI tract. Consequently, WMCs more often inform changes in medication therapy in patients with gastroparesis symptoms and promote greater elimination of additional diagnostic tests than GES. These findings suggest that WMC testing has greater impact than gastric scintigraphy on clinical decision making in suspected gastroparesis.