Opioid Use Is Associated with Prolonged Gastric Transit Time in Hospitalized Patients Receiving Video Capsule Endoscopy

Abstract

Purpose: To investigate the effect of opioids on bowel transit time and completion rate in hospitalized patients undergoing video capsule endoscopy (VCE). Methods: We performed a retrospective review of all hospitalized patients undergoing VCE since the implementation of a new electronic medical record (October 15, 2011 - March 31, 2013). Exclusion criteria included endoscopic placement. Demographic data, medical history, medications and indication for VCE were collected from the medical record. Gastric transit time (GTT), small bowel transit time, total transit time (TTT) and study completion were collected from the VCE report. Transit times were summarized using median and inter-quartile range (IQR) and compared by log-rank analysis. Multivariable logistic regression modeling was utilized with resultant odds ratios (OR) and 95% confidence intervals (95% CI). Results: We performed 157 VCE that met study criteria. Patients without opioids within 48 hours of the VCE had a median GTT of 12 min, IQR 7 - 35 and patients with opioids within 48 hours had a median GTT of 42 min, IQR 12 - 87 (p=0.007). Patients without opioid use were also less likely to have a GTT > 45 min (22% vs. 46%, p= 0.005). There was a trend toward lower total transit times (TTT) in patients not receiving opioids, with a median TTT of 246 min, IQR 189 - 362 compared to 286 min, IQR 212 - > 480 in the opioids group (p= 0.13). There was not a significant difference in VCE completion rate (82% vs. 74%, p=0.28) or gastric capsule retention (2% vs. 5%, p=0.67) between the groups. Demographic data and medical history were similar. After multivariable logistic regression modeling, opioid use was associated with GTT > 45 min (OR 2.96, 95% CI 1.33, 6.61, p=0.008). Conclusion: Opioid use within 48 hours of VCE was significantly associated with prolonged GTT in hospitalized patients. We also found a significant increase in GTT > 45 minutes with opioid use, a benchmark that has been associated with incomplete VCE in previous studies. Although we did not find a significant difference in completion rate with opioid use (perhaps related to sample size), we noted a trend toward longer TTT. This data suggests hospitalized patients should avoid opioids during the 48 hours prior to VCE ingestion to decrease incidence of prolonged GTT.