The Effect of Patient Positioning on Complete Small Bowel Examination Rates with Wireless Capsule Endoscopy

Abstract

Purpose: To evaluate (1) the effect on the gastric emptying time(GET), (2) the proportion of complete SI studies and (3) the diagnostic yield of WCE in patients placed in the right lateral position (RLP) compared with the standing/sitting position post CE ingestion (SSP). Methods: 67 consecutive studies in patients undergoing WCE for investigation of Obscure Gastrointestinal Bleeding (OGIB) from 9/03 – 9/04 were analyzed retrospectively. 9 patients were excluded, 5 (endoscopic placement of the CE), 3 (h/o gastric surgery), 1 (gastroparesis). Patients remained in the RLP or in the sitting/standing position for 30 mins post CE ingestion. Major findings were defined as ulcers, AVMs, strictures, and active bleeding. Results: The 58 remaining studies (31 men, 27 women, age range 16–80), included 35 patients from the RLP group and 23 from the SSP group. The mean GET (time from the first image of the stomach to the first image of the duodenum) in the RLP grp was 27 mins compared with 52 mins in the SSP grp(P < 0.05). The mean small intestinal emptying time was similar in both groups, RLP 207 mins and SSP 203 mins. Major findings were reported in 57% of the RLP grp and 43% of the SSP grp(NS). Stricturing of the SI precluding passage of the CE occurred in 4 cases and 1 case in the RLP and SSP grps respectively. 2 battery failures occurred in the SSP. Otherwise incomplete examinations of the SI were reported in 6% of the RLP grp and 9% of the SPP grp(NS). Conclusions: Positioning patients to the RLP facilitated passage of the CE into the SI without need for promotility agents and should be considered an initial option in the clinical setting. Although there was a numerical trend toward increased diagnostic yield and complete examations of the SI in the RLP grp these were not significant.