Mo2092 Wireless Motility Capsule Alters Diagnosis and Affects Clinical Management in Patients With Suspected Gastrointestinal Dysmotility

Abstract

BACKGROUND: The wireless motility capsule (WMC) is a novel device which is FDAapproved for the evaluation of suspected gastroparesis and slow-transit constipation. WMC provides information regarding pH, temperature and pressure throughout the GI tract and can be used to assess regional and whole-gut transit and pressure patterns. Several studies have validated WMC findings versus standard motility testing; however, there is limited data examining how WMC findings affect clinical care. AIMS: Aims were to investigate (1) the diagnostic yield of WMC in patients with suspected dysmotility and (2) change in clinicalmanagement afterWMC testing, includingmedication changes, referrals for additional diagnostic tests, and outside referrals. METHODS: We retrospectively reviewed 51 consecutive patients referred for WMC at a single, academic tertiary care center from April 2009 to October 2012. Information on demographics, past medical and surgical history, indications for WMC, WMC transit times, and relevant diagnostic studies were collected. Changes in clinical management at the first clinic visit after WMC testing were identified. Patients were excluded if WMC testing was incomplete or if no follow-up information was available. RESULTS: Patient characteristics including demographics and indications are summarized in Table 1. Results of positive WMC testing are summarized in Table 2A. Pan-GI dysmotility was present in 53% of patients with positive WMC testing. Effects of WMC results on diagnosis and management are summarized in Table 2B. Medication changes were more commonly seen in patients with an abnormal WMC test and included the addition or removal of prokinetics, antibiotics, herbal supplements, and neuromodulators. There were no statistically significant differences in additional imaging studies and referrals between the two groups. Referrals to non-GI providers included psychiatry, surgery, nutrition, acupuncture, and biofeedback. The presence of existing psychiatric comorbidities was also similar between groups. Of note, 80% of patients had other diagnostic studies obtained concurrently with WMC testing; however, attempts were made to isolate clinical changes made from WMC results specifically. CONCLUSIONS:WMC affects clinical management in the majority of patients referred for suspected dysmotility. Alteration in diagnosis was frequent, and change in medication was made for the majority of patients with abnormal WMC testing. Pan-GI dysmotility was common in patients referred for suspected regional dysmotility. Normal WMC testing changed clinical management in over 50% of cases. Our results suggest that WMC testing impacts patient care by altering diagnosis and clinical management. Prospective studies are needed to determine how WMC may affect long-term outcomes. Table 1. Patient Characteristics (N=51)