Opioid Use Is Associated With Incomplete Capsule Endoscopy Examinations: A Meta-Analysis and Systematic Review

Abstract

Introduction: Capsule endoscopy (CE) is a non-invasive imaging modality designed with the purpose of evaluating the small bowel, prominently in the setting of evaluation for obscure gastrointestinal (GI) bleeding. Incomplete examination, which is defined as failure to reach the cecum within the battery lifespan, may result in inadequate diagnosis of small bowel pathologies which can lead to delayed intervention or repeated studies. Opioid medications have been previously shown to affect GI motility. Several studies have attempted to evaluate the association between CE completion and opioid use with contradicting results. The aim of this meta-analysis is to evaluate the previously published studies on the association between opioid use and CE completion. Methods: A systemic review was conducted in PUBMED, Embase, Pubmed Central and ScienceDirect databases from inception through June 2018 to identify the studies that evaluated the association between CE completion and opioid use. We used the following keywords in different combinations: “Capsule”, “Endoscopy”, “Opioids”, “Narcotics”. Effect estimates from the individual studies were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird and a pooled odds ratio (OR) was calculated. Forest plots were generated, and publication bias was assessed for using conventional techniques.1158 Figure 1. Forest Plot showing relationship between opioid use and capsule endoscopy completionResults: Five studies with a total of 1614 patients undergoing capsule endoscopy in the inpatient and outpatient setting were included in this study, 349 of whom had an incomplete CE (21.6%). The pooled OR for CE completion is 0.50 (95%CI: 0.38-0.66, I2=36.9%) in opioid users compared to non-users. We found no publication bias as assessed by the funnel plot. Conclusion: Our results indicate that patients on opioids are 50% less likely to have a complete CE examination compared to those not on opioids. To our knowledge, this study represents the first metaanalysis to assess this association. Future prospective randomized research is needed to confirm this association.