Peroral Gastric Placement of Wireless Motility Capsule (WMC; Smartpill®) Under Fluoroscopy: A Novel Method for Patients with Inability to Swallow

Abstract

Purpose: Wireless motility capsule (WMC; Smartpill®) is a cylindrical 2.8-cm-long and 11.7-mm-wide ingestible capsule used to evaluate regional and whole gut transit and motility. It is approved for evaluation of gastric emptying time in patients suspected with gastroparasis and colonic/whole gut transit in constipation or generalized dysmotility. Occasionally patients experience difficulty with swallowing WMC despite no esophageal obstruction. We report a novel approach of capsule placement in patients who experience difficulty with swallowing capsule. Methods: Over 1 year, three patients requiring WMC test failed to swallow capsule despite multiple attempts over more than a 1-hour period. All subjects came to motility lab after an overnight fast, swallowed a 260 kcal Smartbar and 100 mL water. All subjects had normal EGD previously excluding luminal obstruction. They either retained capsule in mouth or spit it back. For patient demographics see Table 1. To facilitate placement, the WMC was grasped by PillCam capsule placing device (Given). After applying oropharyngeal anesthesia with lidocaine, the device with capsule was advanced through the oropharynx into stomach. Under fluoroscopy we confirmed the location of the device tip in stomach. The capsule was released and the device was removed.TableResults: All three subjects had a successful study. The results of WMC are shown in Table 1. We combined orogastric placement with fluoroscopy to ensure that capsule is released in stomach and not in esophagus. One patient had prolonged retention of capsule for longer than 5 days and had a planned endoscopy 4 days later for evaluation of gastroparesis, and retained capsule was removed. All patients benefited from WMC study. No other adverse event was encountered (Table 1). Conclusion: Peroral gastric placement of WMC using capsule placement device and fluoroscopy is feasible, and may serve as a useful method of delivering capsule into the stomach in patients encountering problems with ingestion of WMC. This method may allow performance of the transit/motility study and provide important pathophysiologic information in patients who encounter difficulty with swallowing capsule. Disclosure - Dr. Satish Rao - Consultant: SmartPill Corporation, has received unrestricted and/or reseach grants