Negligible Effects of Erythromycin On Image Quality and Transit Time of Endoscopic Capsule: A Two-Center Study

Abstract

Aim: To compare the effect of oral erythromycin vs. no preparation with prokinetics on the transit time and the image quality of capsular endoscopy (CE) in evaluating small bowel (SB) pathology. Methods: We conducted a retrospective blinded review of 100 CE studies, 50 with no preparation from one medical center (Group A) and 50 from another center which included the administration of a single dose of 200 mg oral erythromycin 1 h prior to CE (Group B). Gastric, SB and total transit times were calculated, the presence of bile in the duodenum was scored, as was cleanliness within the proximal, middle and distal intestine. Results: The erythromycin group had a slightly shorter gastric transit time (21 min versus 28 min for Group A, P = 0.07). SB transit time was similar for both groups (P = 0.83). Total transit time was almost identical in both groups (P = 0.97). The rate of incomplete examination was 16% for Group A and 10% for Group B (P = 0.37). Bile and cleanliness scores in different parts of the intestine were similar for the two groups (P = NS). The use of erythromycin had no effect on image quality (P = 0.73). Conclusions: Preparation for capsular endoscopy with erythromycin does not affect SB or total transit time. It tends to reduce gastric transit time, but it does not increase the cecum-reaching rate. Erythromycin does not adversely affect image quality. We consider the routine use of oral erythromycin preparation as being unfounded, although it might be considered in patients with known prolonged gastric emptying time.