Gastric Transit Time Research Articles

Utilidad de la cápsula endoscópica en el diagnóstico de la enfermedad injerto contra huésped gastrointestinal

Graft-versus-host disease (GvHD) is a complication of hematopoietic cell transplantation, and the small bowel is one of the main targets in the gastrointestinal tract. Capsule endoscopy is a safe procedure and can be useful in the diagnosis of GvHD. The aim of the present study was to compare the diagnostic yield of capsule endoscopy with the histopathologic findings in GvHD. A retrospective diagnostic test study included all the patients with suspected GvHD that underwent gastroscopy and colonoscopy, with histopathologic evaluation of the biopsies taken, and capsule endoscopy, within the time frame of July 2015 and July 2019. Capsule endoscopy findings were compared with the histopathologic diagnosis, considered the gold standard. Twenty-one patients with GvHD (7 [33%] women; 37±11.9 years of age) were included, 20 (95%) of whom had acute GvHD. The median gastric transit time of the capsule was 55minutes (20-113) and the median small bowel transit time was 261minutes (238-434). The entire small bowel was visualized through capsule endoscopy in 17 cases (80.95%). The histopathologic findings and capsule endoscopy findings resulted in the diagnosis of GvHD in 17 and 16 cases, respectively. There was agreement between the histopathologic and capsule endoscopy findings in 18 cases (15 positive and 3 negative). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic yield of capsule endoscopy were 88%, 75%, 94%, 60%, and 85%, respectively. Capsule endoscopy is a safe tool for the diagnosis of GvHD, with high sensitivity and positive predictive value, as well as moderate agreement with histopathologic findings.

The effect of pre-treatment of protein ingredients for infant formula on their in vitro gastro-intestinal behaviour

Three milk products, skim milk powder (SMP), demineralised whey powder (DWP) and a whey dominant infant formula (60/40IF) and their corresponding partially hydrolysed products (SMPhyd, DWPhyd and 60/40hyd, respectively) were subjected to static infant in vitro gastro-intestinal (GI) digestion and their digesta were subsequently analysed for protein breakdown. The pre-hydrolysis of proteins provided a head-start in the gastric digestion process compared with the intact proteins, resulting in a higher proportion of small peptides (<1 kDa), a higher degree of hydrolysis and lower observable protein coagulation or curd formation in the gastric phase of the casein dominant systems in particular, which may lead to an earlier onset of gastric emptying in vivo. Little or no differences were detected during the intestinal phase. Hence pre-hydrolysis of proteins may be used as a strategy to lower gastric transit times, which may ease the gastric digestion of infant formulations.

Gastrointestinal symptoms and cardiac vagal tone in type 1 diabetes correlates with gut transit times and motility index.

Although gastrointestinal (GI) symptoms are common in diabetes, they frequently do not correlate with measurable sensorimotor abnormalities. The wireless motility capsule (WMC) measures pressure, temperature, and pH as it traverses the GI tract wherefrom transit times and motility indices are derived. The aim was to investigate whether GI symptoms correlate with changes in (a) segmental transit times, (b) segmental motility index, (c) cardiac vagal tone, or (d) presence/absence of peripheral neuropathy in type 1 diabetes. Gastrointestinal symptoms in 104 participants with type 1 diabetes were measured using Gastroparesis Cardinal Symptoms Index and Gastrointestinal Symptom Rating Scale. All underwent standardized WMC investigation measuring segmental transit time and motility. Cardiac vagal tone and presence of peripheral neuropathy were measured using electrocardiographic and nerve conduction velocity testing. Colonic transit time was correlated with postprandial fullness (P=.01) and constipation (P=.03), while decreased colonic motility index was correlated with diarrhea (P=.01) and decreased bloating (P<.05). Symptoms were not correlated with gastric or small bowel transit time or motility index. In participants with low cardiac vagal tone, gastric motility index (P<.01) and colonic transit time (P<.05) were increased, but not in those with peripheral neuropathy. Abdominal pain was decreased with both peripheral neuropathy (P=.04) and decreased cardiac vagal tone (P=.02). This study supports the rationale for whole gut investigation, using not only transit times but incorporating contractility indices as well. Furthermore, a decreased parasympathetic modulation and an increased hyposensate state appear to be present in type 1 diabetes.

1113 ASSESSMENT OF CAPSULE ENDOSCOPY UTILIZING CAPSOCAM PLUS® IN PATIENTS WITH SUSPECTED SMALL BOWEL DISEASE INCLUDING PILOT STUDY WITH REMOTE ACCESS PATIENTS

Capsule endoscopy (CE) has been widely utilized for the assessment of patients with known/suspected small bowel disease. The CapsoCam Plus® capsule is unique in that it utilizes four cameras at sequential 90 degree intervals in its mid-section permitting a 360-degree panoramic perspective with a 15+ hour battery life. A panoramic view has been suggested to improve overall visualization of the small bowel (SB) therefore potentially improving diagnostic yield. Unlike other small bowel capsules, it must be retrieved upon excretion (utilizing a magnetic kit) since the images are stored on the device. To assess the use of CapsoCam Plus in patients referred for suspected small bowel disease, including pilot assessments for patients in remote locations. A retrospective chart review (01/16 – 10/19) assessing consecutive capsule procedures utilizing this device was performed. Information acquired included basic demographics, indication, extent of examination, gastric transit time, small bowel transit time, yield, adverse events, capsule retention, recovery rates and recommendations for follow up. A pilot study was also initiated for patients in rural centers to access capsule testing remotely through mail courier without attendance/travel to the primary dispensing site. Acquired data included 65 patients receiving CapsoCam Plus®. Indications: 86% obscure gastrointestinal bleeding, 5% abdominal pain and 1% for IBD. 92% of studies were completed to cecal visualization. Mean gastric and small bowel transit time were 0:48:03 and 3:53:00. 95% were retrieved using retrieval kits provided to patients. 1.5% retrieved endoscopically from the stomach (retained due to pyloric stenosis), 1.5% retained in terminal ileum (previously undiagnosed stricture) and 1.5% not retrieved due to failure of patient to use retrieval kit. 74% of studies were normal SB, 12% contained SB ulceration/erosive disease and 8% did not demonstrate the entire small bowel. Recommendations for follow up included supportive therapy (52%), more aggressive iron supplementation (1%), repeat capsules (17%), further endoscopic evaluation (11%) and 12% for routine office follow up and discussion. All four capsules mailed to patients in remote communities were completed successfully. CapsoCam Plus® had a high retrieval rate of 95% demonstrating that with appropriate patient selection, recovery rates are very high. Only 3% of patients had retained capsules. Most patients in this study had a normal small bowel, however; images and completion rates were adequate to assess small bowel in the vast majority of patients. Success was obtained with mailing this capsule to remote sites sparing the patient travel to the dispensing site.

Tu1554 SMALL BOWEL CAPSULE ENDOSCOPY FOR DIAGNOSIS OF GASTRIC EMPTYING

Gastroparesis is defined as a delay in gastric emptying in the absence of mechanical obstruction. Currently the reference standard for diagnosis is a gastric emptying study (GES). This is a long procedure (up to 4 hours) that requires intake of radiolabeled food. Many patients are unable to tolerate intake of the standard meal due to their symptoms, others are concerned about intake of radioactive isotopes. Capsule endoscopy consists of a pill size camera that visualizes the esophagus, stomach and the small bowel. Our aim was to evaluate gastric transit using a small bowel capsule endoscope and to determine normal gastric transit time. This was a retrospective review of small bowel capsule endoscopy performed in 200 consecutive outpatients at our tertiary referral clinic between 2018 and 2019. All studies were read by a single senior staff attending. Only studies performed with PillCam SB version 3 (Medtronic, Minneapolis, MN) were included. Incomplete studies, patients with altered gastric anatomy or patients with endoscopic small bowel capsule placement were excluded from the study. A total of 200 consecutive patients above the age of 18 years were reviewed. 8 patients were excluded from the study. 192 patients were included in the study, 82 males and 110 females; mean age 57 years old (range 18-89). The most common reason for capsule placement was iron deficiency anemia (115 patients). All causes of capsule placement are summarized in table 1. There was no statistically significant difference between gastric transit times based on the reason for performing the capsule study. The mean capsule gastric emptying time (gastric transit time) was 40.1 minutes (95% CI 31-48) and median time was 16.9 minutes, range from 0.03 minutes to 352.50 minutes. To calculate the extreme values which may represent pathology, we calculated a range two standard deviations above and below the median. Thus, a gastric transit time ≥154 minutes and ≤1.6 minutes may represent pathologic outcomes of delayed and rapid gastric emptying. 175/192 (91%) of patients in our cohort were between two standard deviations. Of this cohort of consecutive patients, 11 patients underwent both capsule endoscopy and gastric emptying study. Using our model on this cohort, 63% (7/11) patients had a GTT within 2 SDs and were confirmed to have a normal GES. This is the first study per our knowledge to use capsule endoscopy to evaluate gastric transit time. Since capsule endoscopy is currently not approved for diagnosis of gastroparesis, this study is limited by a lack of direct comparison to the reference standard. However, it forms a basis for further research. In patients with gastric transit time <5th or >95th percentile providers should maintain a high index of suspicion for rapid gastric emptying and gastroparesis respectively.Table 1Reasons for Capsule placementView Large Image Figure ViewerDownload Hi-res image Download (PPT)

A151 ASSESSMENT OF CAPSULE ENDOSCOPY UTILIZING CAPSOCAM PLUS® IN PATIENTS WITH SUSPECTED SMALL BOWEL DISEASE INCLUDING PILOT STUDY WITH REMOTE ACCESS PATIENTS

Abstract Background Capsule endoscopy (CE) has been widely utilized for the assessment of patients with known/suspected small bowel disease. The CapsoCam Plus® capsule is unique in that it utilizes four cameras at sequential 90 degree intervals in its mid-section permitting a 360-degree panoramic perspective with a 15+ hour battery life. A panoramic view has been suggested to improve overall visualization of the small bowel (SB) therefore potentially improving diagnostic yield. Unlike other small bowel capsules, it must be retrieved upon excretion (utilizing a magnetic kit) since the images are stored on the device. Aims To assess the use of CapsoCam Plus in patients referred for suspected small bowel disease, including pilot assessments for patients in remote locations. Methods A retrospective chart review (01/16 – 09/19) assessing consecutive capsule procedures utilizing this device was performed. Information acquired included basic demographics, indication, extent of examination, gastric transit time, small bowel transit time, yield, adverse events, capsule retention, recovery rates and recommendations for follow up. A pilot study was also initiated for patients in rural centers to access capsule testing remotely through mail courier without attendance/travel to the primary dispensing site. Results Acquired data included 63 patients receiving CapsoCam Plus®. Indications: 32% obscure gastrointestinal bleeding, 52% iron deficiency anemia, 2% abdominal pain and 6% for IBD. 92% of studies were completed to cecal visualization. Mean gastric and small bowel transit time were 0:48:17 and 3:54:29. 94% were retrieved using retrieval kits provided to patients. 2% retrieved endoscopically from the stomach (retained due to pyloric stenosis), 2% retained in terminal ileum (previously undiagnosed stricture) and 2% not retrieved due to failure of patient to use retrieval kit. 73% of studies were normal SB, 13% contained SB ulceration/erosive disease and 8% did not demonstrate the entire small bowel. Recommendations for follow up included supportive therapy (47%), more aggressive iron supplementation (1%), repeat capsules (19%) and 14% for routine office follow up and discussion. All three capsules mailed to patients in remote communities were completed successfully. Conclusions CapsoCam Plus® had a high retrieval rate of 97% demonstrating that with appropriate patient selection, recovery rates are very high. Only 3% of patients had retained capsules. Most patients in this study had a normal small bowel, however; images and completion rates were adequate to assess small bowel in the vast majority of patients. Success was obtained with mailing this capsule to remote sites sparing the patient travel to the dispensing site. Funding Agencies None

Defining gastrointestinal transit time using video capsule endoscopy: a study of healthy subjects.

Background and study aims Determining the etiology and location of gastrointestinal motility disorders can be challenging. A range of investigations targeting specific areas of gastrointestinal transit are available, but many provide clinical data for a given gastrointestinal region alone or for non-specific whole gut transit, and are otherwise of limited use. Video capsule endoscopy allows endoscopic visualisation of the entire gastrointestinal tract, and may also provide more specific data for regional transit time abnormalities. Patients and methods Data from video capsules ingested by 71 ambulatory healthy subjects were recorded and analyzed to determine gastric and small bowel transit times in the fasting state. Results Median, and interquartile range (IQR), gastric transit time was 22 (10–48) minutes, and median (IQR) small bowel transit time was 198.5 (157–240.5) minutes. Conclusion These data, for the first time to our knowledge, provide references for gastrointestinal transit times among healthy ambulatory subjects using video capsule endoscopy. This potentially strengthens clinical use of video capsule endoscopy in the investigation of patients with suspected gastrointestinal motility disorders.

Capsule Endoscopy Transit Time to Duodenum: Relation to Patient Demographics.

BackgroundAnesthesia guidelines recommend fasting for at least two hours to minimize aspiration risk related to endoscopic procedures, and the American Society for Gastrointestinal Endoscopy (ASGE) states that the final oral preparation liquid can be administered three to eight hours before the procedure. We have observed the cancellation of endoscopy procedures if liquids were consumed within four, six, or eight hours of the start time. Objectively, documenting gastric transit time via a review of pill endoscopy data could address clinician concerns, prevent delays in patient care, and improve the rate at which our clinicians practice within national guidelines. The objective was to utilize capsule endoscopy data from our center to report the relationship between patient factors that could affect gastric transit time (GTT) and small bowel transit time (SBTT) such as chronic kidney disease (CKD), diabetes mellitus (DM), nutritional status, and obesity.MethodsThis retrospective review obtained data on adult pill endoscopy (PillCam™ SB 3) (Medtronic, Minneapolis MN) studies on in- and outpatients. Past medical history and laboratory data were abstracted from electronic medical records. Mean GTT and SBTT are reported in minutes + standard deviation (SD) and times were compared accounting for conditions that could prolong transit, such as diabetes mellitus or chronic kidney disease (CKD).ResultsOne hundred and sixty-three records reviewed. Four patients were excluded as the pill did not pass out of the stomach. The mean age was 66 years, 57% were female, and 26% were evaluated for gastrointestinal (GI) bleeding. The mean GTT for all patients (n = 159) was 35 + 49 with a median of 19 minutes. There were no statistically significant differences in GTT between the following subgroups: CKD0 (n = 100) 40 + 58 versus CKD5 (n = 11) 35 + 39, albumin > 3.0 (n = 123) 37 + 53 versus albumin < 3.0 (n = 36) 27 + 30, diabetes mellitus (DM) (n = 40) 51 + 71 vs. non-DM (n = 119) 42 + 79, body mass index (BMI) > 30, or aspirin use. The SBTT results in all patients (n = 124) was 238 + 88 minutes. Similarly, there was no relation between SBTT and albumin, any CKD, CKD0 versus CKD5, DM status, or BMI. The patients with the capsule stuck in the stomach did not have any other clinical history to explain this occurrence.ConclusionsThis analysis of objective data regarding pill endoscopy found that the mean GTT was 44 minutes, and it was < 60 minutes for 85% of the cohort. Patient factors were not associated with longer transit times, and this is the first report to document PillCam times in relation to CKD. These data support recommendations that endoscopic procedures, in accordance with anesthesia and ASGE guidelines, can be safely conducted in the majority of patients within 60 minutes of ingesting liquids.

Optimal Bowel Preparation for Capsule Endoscopy and Device-assisted Enteroscopy

For improved examination of video capsule endoscopy (VCE) and device-assisted enteroscopy (DAE), bowel preparation is an essential issue. Multiple factors like air bubbles, food material in the small bowel, and gastric and small bowel transit time affect the small bowel visualization quality (SBVQ), diagnostic yield (DY) and cecal completion rate (CR). Bowel preparation with polyethylene glycol (PEG) solution enhances SBVQ and DY, but it has no effect on CR. Bowel preparation with PEG solution 2 L is similar to PEG 4 L in SBVQ, DY, and CR. Bowel preparation with fasting or PEG solution combined with anti-foaming agents like simethicone enhance SBVQ, but it has no effect on CR. Bowel preparation with prokinetics is not commonly recommended. Optimal timing for purgative bowel preparation has yet to be established. However, the studies regarding bowel preparation for DAE are not sufficient. European Society of Gastrointestinal Endoscopy (ESGE) recommends 8-12 hours fasting from solid food and 4-6 hours fasting from liquids prior to the antegrade DAE. For retrograde DAE, colonoscopy preparation regimen is recommended. This article reviews the literature and ESGE, 2013 Korean published guidelines regarding bowel preparation for VCE and DAE, following suggestion for optimal bowel preparation for VCE and balloon enteroscopy.

Water Tolerance After Laparoscopic Sleeve Gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) is taking the lead as the most popular bariatric procedure in most regions of the world. Unlike other liquids, water is particularly affected by LSG. Because of its importance for safe hospital discharge, weight loss, and patients' lifestyle, we evaluated water tolerance after LSG. The study included 106 consecutive patients who underwent LSG. All patients had upper gastrointestinal series (UGI) 48h (early) and 3months postoperatively (late), during which flow patterns (esophageal and gastric transit time) for water and juice were measured and correlated with subjective tolerance for water and juice at the same time of the contrast studies. Intraoperative measurements of the sleeve were also correlated with subjective tolerance. One-hundred and two (94 females, 92%) completed the 3-month follow-up. The mean age was 30.75years; mean pre-operative BMI 46.76kg/m2. The mean %EWL after 3months was 32.17% ± 9.5%. Fifty patients (49%) expressed early difficulty drinking water (EDDW), and 30 (29.41%) showed late difficulty drinking water (LDDW), compared with 8 patients (7.8%) with early difficulty drinking juice (EDDJ) and 6 (5.9%) with late difficulty drinking juice (LDDJ). LSG reduces water tolerance significantly more than other liquids (juice) in the early postoperative period. Good water tolerance is a critical parameter for early hospital discharge after LSG. Larger studies with longer follow-up are warranted to determine the long-term fate of fluid tolerance following LSG and its effect on weight loss and quality of life.

Evaluating a combined bowel preparation for small-bowel capsule endoscopy: a prospective randomized–controlled study

BackgroundCapsule endoscopy (CE) is frequently hindered by intra-luminal debris. Our aim was to determine whether a combination bowel preparation would improve small-bowel visualization, diagnostic yield, and the completion rate of CE.MethodsSingle-blind, prospective randomized–controlled study of outpatients scheduled for CE. Bowel-preparation subjects ingested 2 L of polyethylene glycol solution the night prior to CE, 5 mL simethicone and 5 mg metoclopramide 20 minutes prior to CE and laid in the right lateral position 30 minutes after swallowing CE. Controls had no solid food after 7 p.m. the night prior to CE and no liquids 4 hours prior to CE. Participants completed a satisfaction survey. Capsule readers completed a small-bowel-visualization assessment.ResultsFifty patients were prospectively enrolled (56% female) with a median age of 54.4 years and 44 completed the study (23 patients in the control group and 21 in the preparation group). There was no significant difference between groups on quartile-based small-bowel visualization (all P > 0.05). There was no significant difference between groups in diagnostic yield (P = 0.69), mean gastric (P = 0.10) or small-bowel transit time (P = 0.89). The small-bowel completion rate was significantly higher in the preparation group (100% vs 78%; P = 0.02). Bowel-preparation subjects reported significantly more discomfort than controls (62% vs 17%; P = 0.01).ConclusionsCombined bowel preparation did not improve small-bowel visualization but did significantly increase patient discomfort. The CE completion rate improved in the preparation group but the diagnostic yield was unaffected. Based on our findings, a bowel preparation prior to CE does not appear to improve CE performance and results in decreased patient satisfaction (ClinicalTrials.gov, No. NCT01243736).

Postanaesthetic effects of ketamine–midazolam and ketamine–medetomidine on gastrointestinal transit time in rabbits anaesthetised with isoflurane

BackgroundGastrointestinal stasis is a common perianaesthetic complication in rabbits. The objective of this study was to assess the impact on gastrointestinal transit time of ketamine–midazolam (KMZ) versus ketamine–medetomidine (later antagonised...

Prospective study of the changes in pharmacokinetics of immunosuppressive medications after laparoscopic sleeve gastrectomy.

Laparoscopic sleeve gastrectomy induces weight loss via the creation of a restrictive gastric tube for early satiety and is associated with an accelerated gastric transit time. A prospective, single-dose pharmacokinetic study was performed, prior to and after laparoscopic sleeve gastrectomy, for tacrolimus, extended-release tacrolimus, mycophenolate mofetil, and enteric-coated mycophenolate sodium. The study included 12 morbidly obese patients in chronic renal failure. The median decrease in body mass index was 8.8kg/m2 with an excess body weight loss of 54.9%. The AUC24 of all drugs were increased after laparoscopic sleeve gastrectomy by 46%, 55%, 77%, and 74%, respectively. The maximum concentrations were increased for tacrolimus, extended-release tacrolimus, and mycophenolate mofetil by 43%, 46%, and 65%. The apparent total clearances were decreased for tacrolimus, mycophenolate mofetil, and enteric-coated mycophenolate sodium by 36%, 57%, and 38%. Laparoscopic sleeve gastrectomy can be associated with significant changes in pharmacokinetics of the drugs evaluated. The mechanism is likely decreased apparent drug clearance due to an increased drug exposure (from a more distal site of intestinal absorption with decreased intestinal metabolism), or decreased clearance (liver metabolism). Adapting the monitoring of immunosuppression will be important to avoid overdosing and potential side effects.

1182 Small Intestinal Bacterial Overgrowth (SIBO) Is Common in Patients With Ehlers-Danlos Syndrome (EDS)

INTRODUCTION: EDS is a group of rare connective tissue disorders caused by defects in collagen synthesis. EDS patients frequently have chronic gastrointestinal (GI) symptoms. Delayed gastric emptying and colonic transit time are common in EDS, suggesting underlying GI dysmotility. The relationship between SIBO and EDS has not been studied. In this study, we aimed to assess the prevalence of SIBO by glucose hydrogen breath test (GBT) in EDS patients with GI symptoms. We also characterized the risk factors for SIBO in these patients. METHODS: This was a retrospective cohort study of adults with EDS from specialty clinics at University of Michigan (2000-2019) who completed GBT for suspected SIBO. Demographics, history, medications, and GBT findings were reviewed. Patients with documented structural disease (eg. neoplasm) were excluded. GI symptoms were prospectively collected from all patients at their GBT. A priori variables associated with SIBO were analyzed including: presence of diabetes, GERD, and gastroparesis; history of small bowel surgery or gastric bypass; use of opioids or proton pump inhibitors. Positive GBT for SIBO was defined as breath H2 rise ≥20 ppm within 90 min and/or CH4 rise ≥10 ppm at any time after glucose ingestion. Statistical methods included chi-square and t test. Univariate regression analysis assessed the relationship between tested variables and GBT outcome. RESULTS: A total of 600 EDS patients were identified and 327 (54.5%) had at least one GI symptom. GBT was performed in 39 patients (mean age 37.6 ± 12.9; 94.8% female; 92.3% Caucasian) for suspected SIBO. Common symptomatic indications in these patients are shown in Table 1. 15 patients (38.5%) had positive GBT by either H2 (n = 11; 28.2%) and/or CH4 (n = 7; 17.9%). There were no significant differences in demographic factors between EDS patients with positive and negative GBT. Symptomatically, the presence of bloating was associated with a positive GBT (P = 0.04) but there was no significant association between any other GI symptom and the GBT outcome. Diagnosis of GERD was significantly associated with a positive GBT (P = 0.04) and there was a trend towards significant association between IBS and positive GBT (P = 0.07). None of other tested variables predicted the GBT outcome. CONCLUSION: SIBO diagnosed by GBT is common in EDS patients with chronic GI symptoms. Our preliminary results suggest that SIBO should be particularly considered in EDS patients with bloating and GERD. Further study is needed to delineate this relationship.

A study on the difference of gastrointestinal transit time with minimized capsule endoscope in dogs

This study compares the differences in the gastrointestinal transit time between the conventional capsule endoscope and a minimized capsule endoscope model in normal dogs to verify whether the minimization of capsule endoscope can help relief retention in the gastrointestinal tract, especially in the pyloric passage. Three male beagles were used as the experimental group for which the minimized capsule endoscope model was orally administered and the control group consisted of three beagle dogs for which the conventional capsule endoscope was orally administered. Nine experiments were conducted with three experiments for each dog in each group. The results showed a significant difference in the gastric transit time (GTT) by the minimization of the capsule endoscope between the two groups (control group: 123.3 ± 80 min, experimental group: 63.3 ± 40.9 min, p=0.019). In contrast, the difference in the small bowel transit time (SBTT) by the minimization of the capsule endoscope between the two groups (control group: 86.6 ± 58.9 min, experimental group: 80 ± 33.5 min, p=0.863) was not significant. In this study, the capsule endoscopes reached the large intestine without retention in the small intestine in all subjects. The significant difference in the GTT between the control group using the conventional capsule endoscope and the experimental group using the minimized capsule endoscope model suggests that the smaller size of the capsule endoscope is helpful in resolving retention in the gastrointestinal tract, thus shorting the GTT.

Gastric dysmotility in Parkinson's disease is not caused by alterations of the gastric pacemaker cells

The enteric nervous system is involved in the pathology of Parkinson´s disease and patients frequently have symptoms related to delayed gastric emptying. However, the pathophysiology of gastric dysmotility is yet not well understood. The objective of this study was to assess interdigestive gastric motility in Parkinson´s disease. Using an electromagnetic capsule system, the dominant gastric contraction frequency (primary outcome measure) and the gastric transit time were assessed in 16 patients with Parkinson´s disease and 15 young healthy controls after a fasting period of 8 h. Motor and non-motor symptoms were assessed using the Movement Disorder Society Unified Parkinson´s Disease Rating Scale III (MDS-UPDRS III), the Non-Motor Symptoms Questionnaire (NMS-Quest), and Hoehn & Yahr staging. The Gastroparesis Cardinal Symptom Index was used to record symptoms related to delayed gastric emptying. In healthy controls and patients with Parkinson's disease, the dominant contraction frequency was 3.0 cpm indicating normal function of interstitial cells of Cajal. In patients with Parkinson's disease, the gastric transit time was longer than in younger controls (56 vs. 21 min). The dominant contraction frequency and gastric transit time did not correlate with age, disease duration, Hoehn & Yahr stage, levodopa equivalent daily dose, MDS-UPDRS III, NMS-Quest, and Gastroparesis Cardinal Symptom Index. Changes of gastric motility in Parkinson´s disease are not caused by functional deficits of the gastric pacemaker cells, the interstitial cells of Cajal. Therefore, gastroparesis in Parkinson's disease can be attributed to disturbances in neurohumoral signals via the vagus nerve and myenteric plexus.

Feasibility and safety of magnetically guided capsule endoscopy in minors

Objective: To clarify the feasibility and safety of magnetically guided capsule endoscopy (MGCE) in minors. Methods: A descriptive cohort study was carried out to retrospectively collect the data of minors (<18 years) who underwent MGCE in Ruijin Hospital from April 2015 to October 2018. Exclusion criteria: patients with dysphagia, obvious gastrointestinal bleeding, diagnosed or suspected gastrointestinal obstruction, or congenital gastrointestinal malformations or intestinal fistula; patients with previous bowel surgery, or in poor general condition; patients with implants; pregnant patients; patients with incomplete data or without data. A total of 218 patients, including 122 males and 96 females, with mean age of (12.0±3.1) (5-17) years and 236 times of examination were included. The capsule size of the Ankon MGCE system was 11.8 mm×27 mm, taking two pictures per second, with a viewing angle of 140 degrees. Data of gastric visualization (0% to 100%), gastric cleanliness (satisfactory cleanliness was defined as a clear display of the gastric mucosa; the effect of bubbles or mucus on the visual field was negligible, or the gastric mucosa was slightly blurred; a small amount of air bubbles or mucus affected slightly the field of view), gastric or small bowel examination time, lesion detection rate, etc. were recorded. All the patients were followed up for 2 weeks to confirm capsule excretion and to record adverse events. Results: A total of 202 patients (217 times) completed gastric examination and 112 patients (125 times) completed small bowel examination. The median gastric visualization of cardia, fundus, body, angulus, antrum and pylorus was 100%, 90% (75%,100%), 100% (80%,100%), 100%, 100%, and 100%, respectively. The cleanliness of the gastric cardia, fundus, body, angle, antrum, and pylorus was assessed to be satisfactory in 100.0%, 76.5% (153/200), 92.5% (185/200), 97.5% (195/200), 99.5% (199/200), and 100.0% of patients, respectively. In 202 patients undergoing gastric examination, the median gastric exanimation time was 10.5 (7.3, 13.9) minutes. In 112 patients undergoing small bowel examination, the median gastric transit time was 51.5 (20.6, 112.0) minutes and the median small bowel transit time was 232.4 (181.8, 321.6) minutes. The small bowel transit rate was 91.1% (102/112). The lesion detection rates of stomach, duodenum and jejunoileum were 18.8% (38/202), 8.1% (10/124) and 26.8% (30/112) respectively. No complications or adverse events occurred. Conclusion: MGCE is feasible and safe to detect both gastric cavity and small bowel in minors.

Magnetically Controlled Capsule Endoscopy in Children: A Single-center, Retrospective Cohort Study.

Capsule endoscopy (CE) is a noninvasive diagnostic tool for the digestive tract. We aim to investigate the feasibility and safety of newly developed magnetically controlled capsule endoscopy (MCE) in children. A total of 129 children who underwent MCE in Shanghai Children's Hospital were retrospectively recruited between March 2016 and August 2018. The feasibility, positive findings, and safety of MCE were evaluated and systematically analyzed. Of all those children, 68 were boys, and 61 were girls with a mean age of 9.8 ± 1.9 years (6-14 years). The MCE procedure was feasible in all children. The mean esophageal transit time was 6.0 ± 4.6 seconds. The mean gastric examination time was 14.4 ± 3.9 minutes, and the average gastric transit time was 83.9 ± 59.1 minutes. Positive findings were detected in 82 children (82/129, 63.6%), 1 had esophageal lesions, 30 had superficial gastritis, 14 had superficial gastritis with bile reflux, 18 had nodular gastritis, 1 had ulcers, and 2 had heterotopic pancreas. There were 5 patients who had duodenal bulbar ulcers. One had lymphatic follicle, 1 had celiac disease, 1 had blue rubber bleb nevus syndrome, and 2 polyps were detected in 16 patients who were examined the small bowel. No serious adverse event was reported during the MCE examination and follow-up, and all subjects excreted the capsules spontaneously within 2 weeks. We showed that MCE is feasible and safe in children above 6 years. More studies are needed to further investigate the efficacy of MCE in children.

Effect of prokinetics on the gastrointestinal transit of a capsule endoscope in healthy 4 beagles

This study investigated the prokinetic effect of metoclopramide and mirtazapine on gastric transit time (GTT), small bowel transit time (SBTT) and gastrointestinal transit time (GITT) during capsule endoscopy in four healthy beagle dogs. Four beagle dogs participated in the experiment as four groups at intervals of more than three days as the following: Control group 1 (capsule alone), Control group 2 (capsule alone), Metoclopramide administered group (metoclopramide + capsule) and Mirtazapine administered group (mirtazapine + capsule). The results of this study demonstrated there was no significant difference in GTT ([min] control group 1: 105 ± 90, control group 2: 172.5 ± 102 vs metoclopramide administered group: 247.5 ± 93, p = 0.07, 0.10) and SBTT ([min] control group 1: 120 ± 88, control group 2: 75 ± 39 vs metoclopramide administered group: 37.5 ± 15, p = 0.20, 0.18) for capsule only administered groups (control group 1 & 2) compared to metoclopramide administered group. In addition, there was no significant difference in GTT ([min] control group 1: 105 ± 90, control group 2: 172.5 ± 102 vs mirtazapine administered group: 127.5 ± 45, p = 0.56, 0.36) and SBTT ([min] control group 1: 120 ± 88, control group 2: 75 ± 39 vs mirtazapine administered group: 157.5 ± 38, p = 0.29, 0.07) between capsule only administered groups (control group 1 & 2) and mirtazapine administered group. In this study, the fact that metoclopramide might be ineffective and administration of mirtazapine might be inadequate in dogs were confirmed.

Su1325 PROLONGED OPERATING TIME HAVE A SUBSTANTIAL EFFECT ON PROMOTING COMPLETE EXAMINATION RATE OF CAPSULE ENDOSCOPY COMPARED WITH ENDOSCOPIC DELIVERY OF CE ALONE

Small bowel capsule endoscopy (SB CE) has become the gold standard for the investigation of small bowel diseases. The most common applications of CE include obscure gastrointestinal bleeding (OGIB), suspected Crohn’s disease, small-intestine tumors and polyps, etc. The diagnostic yield of SB CE has been reported to vary widely and can be affected by many factors, such as indications, bowel preparation, reviewers’ experience, and so on. Complete examination was defined as capsule passing through the whole small intestine during its working time, and the complete examination rate (CER) is also one of the important factors that can influences the diagnostic yield of CE. Some methods have been adopted to promote the CER; among them are real-time monitoring plus endoscopic delivery of CE into the duodenum and prolonging examination time with increased battery life. In order to study which of the two methods mentioned above is more effective for improving the CER, three types of modality of CE examination were analyzed. We conducted a retrospective review of 241 consecutive patients, 61 of whom had undergone 8-h PillCam SB CE (8 h operating time) from July 2005 to April 2011 without real-time monitoring, 7 consecutive 8-h PillCam SB CE and 173 consecutive 12 h PillCam SB2-ex (12 h operating time) patient all with real-time monitoring and endoscopic delivery of CE if necessary (CE unable pass through the pylorus 1.5 h after the start of the inspection) from July 2011 to November 2018. We grouped the patients as follows: A, 61 cases 8-h PillCam CE without real-time monitoring; B, 180 cases 8-h PillCam CE with monitoring (7 actual 8 h, and 173 actual 12 h but assumed the CE only work for 8 h and only data of the former 8 h were calculated); C, 173 cases 12 h PillCam SB2-ex actual data. GTT (gastric transit time), SBTT (Small bowel transit time) and CER of the three groups were analyzed. We found that twenty-nine (16.1%, 29/180) endoscopic delivery of CE were performed in group B, but there was no difference between group A and B in GTT, SBTT or CER. CER of group C (94.8%, 164/173) was much higher than that of group A (78.7%, 48/61) or B (72.8%, 131/180) (Chi-square test with Bonferroni correction; C vs. A, p ＜ 0.01 & C vs. B, p ＜ 0.001), and SBTT of group C (322.0 ± 133.1 min) was much longer than that of group A (253.8 ± 80.9 min) or B (269.3 ± 98.4 min) (One-Way ANOVA Tamhane's T2 or Dunnett's T3 test; C vs. A & C vs. B, p ＜ 0.001) (table 1). In conclusion, longer operating time have a substantial effect on promoting complete examination rate of CE, while endoscopic delivery of CE have little or no effect on it. Endoscopic delivery of CE plays a role in eliminating the risk of inspection failure, such as unable to ingestion, or excessive time wasted in the esophagus or stomach, but too early or too frequently endoscopic delivery of CE is not necessary.