Mean Small Bowel Transit Time Research Articles

Clean mucosal area detection of gastroenterologists versus artificial intelligence in small bowel capsule endoscopy.

Studies comparing the detection of clean mucosal areas in capsule endoscopy (CE) using human judgment versus artificial intelligence (AI) are rare. This study statistically analyzed gastroenterologist judgments and AI results. Three hundred CE video clips (100 patients) were prepared. Five gastroenterologists classified the video clips into 3 groups (≥75% [high], 50%-75% [middle], and < 50% [low]) according to their subjective judgment of cleanliness. Visualization scores were calculated using an AI algorithm based on the predicted visible area, and the 5 gastroenterologists' judgments and AI results were compared. The 5 gastroenterologists evaluated CE clip video quality as "high" in 10.7% to 36.7% and as "low" in 28.7% to 60.3% and 29.7% of cases, respectively. The AI evaluated CE clip video quality as "high" in 27.7% and as "low" in 29.7% of cases. Repeated-measures analysis of variance (ANOVA) revealed significant differences in the 6 evaluation indicators (5 gastroenterologists and 1 AI) (P < .001). Among the 300 judgments, 90 (30%) were consistent with 5 gastroenterologists' judgments, and 82 (91.1%) agreed with the AI judgments. The "high" and "low" judgments of the gastroenterologists and AI agreed in 95.0% and 94.9% of cases, respectively. Bonferroni's multiple comparison test showed no significant difference between 3 gastroenterologists and AI (P = .0961, P = 1.0000, and P = .0676, respectively) but a significant difference between the other 2 with AI (P < .0001). When evaluating CE images for cleanliness, the judgments of 5 gastroenterologists were relatively diverse. The AI produced a relatively universal judgment that was consistent with the gastroenterologists' judgements.

Non-small-bowel lesions identification by capsule endoscopy: A single centre retrospective study

Capsule endoscopy has been considered the first-line approach for the investigation of obscure gastro-intestinal bleeding since its approval in 2001. Our study aims to evaluate the diagnostic yield of capsule endoscopy in the investigation of this condition. We also analyse the incidence of non-small-bowel lesions missed after conventional endoscopy and later detected by capsule endoscopy in patients with suspected obscure bleeding. A total of 290 patients with negative conventional endoscopy referred to our centre to undergo a capsule endoscopy examination for the investigation of obscure gastro-intestinal bleeding. We considered as non-small-bowel lesions those outside the tract between the second duodenal portion and the ileocecal valve. We also looked for actively bleeding lesions at the time of the exam. Intestinal preparation was good, adequate or poor in 74.1%, 8.4%, and 17.5% of the tests, respectively. Caecum was reached in 92.4%. Capsule retention occurred in 0.7%. Mean small bowel transit time was 5hours and 13minutes. Diagnostic yield was 73.8%. An actively bleeding lesion was noticed in 39.3% of positive tests. Capsule endoscopy revealed clinically significant non-small-bowel lesions missed at gastroscopy or colonoscopy in 30.3% of patients, 43.2% of which were bleeding. Capsule endoscopy has high diagnostic yield and safety in the investigation of obscure gastro-intestinal bleedings. Given the high percentage of non-small-bowel lesions detected, it may be appropriate to consider an endoscopic second look before performing a capsule endoscopy study.

Variation in small bowel transit time on capsule endoscopy.

BackgroundSmall bowel motility remains inadequately understood because of the complex and various functions as well as its anatomical position. The aimed of the study was to investigate the small bowel transit time (SBTT) of capsule endoscopy (CE) and to analyze the clinical factors affecting SBTT.MethodsSBTT was analyzed in patients who underwent small bowel CE. Factors contributing to SBTT and CE retention were investigated.ResultsAmong 397 patients enrolled in this study, 336 (84.6%) completed CE. The mean SBTT (± standard deviation) was 282.1±132.2 min. According to the univariate and multivariate analyses, aging and small bowel stenosis extended SBTT. In 38 patients who underwent multiple CE studies, considerable variation in SBTT were observed [mean of standard deviations (SDs) =97.97 min, SD of the SDs =81.99 min]. CE retention was observed in 61 patients (13.3%), and it was statistically associated to small bowel lesion.ConclusionsAging and small bowel stenosis were associated with longer SBTT. Furthermore, SBTT analyzed by CE should be interpreted carefully considering the intra-individual differences in SBTT.

Small Intestinal Transit Time Is Delayed in Small Intestinal Bacterial Overgrowth.

Altered small intestinal motility is thought to contribute to the development of small intestinal bacterial overgrowth (SIBO). The clinical manifestations of SIBO and consequent malabsorption are wide ranging and include abdominal pain, bloating, diarrhea, weight loss, and nutritional deficiencies. However, due to the nonspecific nature of symptoms, the diagnosis may often be overlooked. To date, few studies have illustrated a direct relationship between impaired small intestinal motility and SIBO. In addition, further study has been limited by the technical challenges and lack of widespread availability of antroduodenal manometry. The development of a wireless motility capsule (WMC) (SmartPill) that evaluates pressure, pH, and temperature throughout the GI tract offers the potential to identify patients with small bowel transit delays who may be at risk for bacterial overgrowth. The primary aims of this study were to: (1) characterize the relationship of prolonged small bowel transit time (SBTT) in patients undergoing WMC with SIBO as based on a positive lactulose breath testing (LBT); and (2) to assess the relationship of prolonged gastric, colonic, and whole gut transit times (WGTT) and additional motility parameters with SIBO (positive LBT). We also sought to evaluate the relationship of small bowel motility parameters (SB motility index, contractions per minute, and SB peak amplitudes) with LBT results. We performed a retrospective study of consecutive patients who were referred for wireless motility testing at a single, tertiary care institution from April 2009 to December 2012. Of the 72 total patients identified, 34 underwent both WMC and LBT. Gastric, small bowel, colonic, WGTT, and SB motility parameters were measured and correlated with LBT results. Statistical methods utilized for data analysis include ANOVA, 2-sample t tests, nonparametric Kruskal Wallis test, Wilcoxon rank-sum test, and the Fisher exact test. Of the 37 patients who underwent both WMC and LBT, 24 (65%) were LBT positive. The mean SBTT among those who were LBT positive was 6.6 hours as compared with 4.2 hours in those who were LBT negative (P=0.04). Among patients who were LBT positive, 47.6% had prolonged SBTT (≥6 h), whereas only 7.7% of those who were LBT negative had a delay in their SBTT (P=0.01). In addition, patients who were LBT positive were more likely to have prolongation of both colonic and WGTT versus those who were LBT negative (CTT: positive LBT=64.4 h vs. negative LBT=35.5 h, P=0.02; WGTT: positive LBT=70.5 h vs. negative LBT=44.1 h, P=0.02). However, there were no statistical differences observed between the groups for gastric emptying times or other small intestinal motility parameters (SB motility index, contractions per minute, and peak amplitudes) between the 2 groups. Patients with underlying SIBO have significant delays in SBTT as compared with those without. The association between prolonged SBTT and positive LBT may be useful in identifying those patients with SIBO diagnosed by LBT and potentially target therapeutic options for those refractory to standard therapy. Interestingly, patients with positive LBT did not necessarily have a generalized gastrointestinal motility (similar GETs among groups), suggesting that small bowel transit specifically predisposes to the development of SIBO. Future, prospective studies are needed to further characterize intestinal dysmotility and other contributing pathophysiological mechanisms in SIBO and to investigate the potential benefits of prokinetics in this challenging patient population.

PWE-182 Dysmotility In Parkinson’s Disease Correlates To Gut Symptoms: Findings Of A Wireless Motility Capsule Study

IntroductionParkinson’s disease (PD) is a neuro-degenerative disorder with frequent involvement of the gut. Symptoms arise throughout the gastrointestinal tract through dysmotility secondary to autonomic and enteric nervous system involvement, as...

Sa2024 Dysmotility in Parkinson's Disease Correlates to Gut Symptoms: Findings of a Wireless Motility Capsule Study

Introduction Parkinson’s disease (PD) is a neuro-degenerative disorder with frequent involvement of the gut. Symptoms arise throughout the gastrointestinal tract through dysmotility secondary to autonomic and enteric nervous system involvement, as well from skeletal muscle involvement in the oropharynx and anorectum. It has been speculated that gut involvement may precede motor symptoms. The Wireless Motility Capsule (WMC) yields data on transit and motility throughout the gut. We report the first use of WMC to systematically assess motility in PD patients with and without gut symptoms, compared to controls. Methods 15 patients with established PD completed the study: eight (2 f, mean age 70 [47–85]) had GI symptoms and seven (2 f, mean age 61 [49–77]) did not based on history and baseline scores on the Gastroparesis Cardinal Symptom Index (GCSI) and Wexner constipation score. Data comparison with seven controls (3f, mean age 52 [39–63]). Medications affecting GI motility /pH were discontinued for the study and the WMC was ingested following a standardised nutrient bar meal. Data on gastric emptying time (GET), small bowel transit time (SBTT), colonic transit time (CTT) and whole gut transit time (WGTT) were calculated. Results PD patients with gut symptoms showed significantly slower transit in the stomach (GET 5.2 vs. 2.7 h, p = 0.0003), colon (CTT 57.8 vs. 27.4 h, p = 0.02) and overall gut (WGTT 67.2 vs. 34.7 h, p = 0.02) compared to asymptomatic patients. Small Bowel transit (mean SBTT 4.17 h) did not significantly differ. GET, SBTT, CTT and WGTT did not differ between asymptomatic PD and controls. There was a significant correlation between the Wexner constipation score and CTT in all patients (p 0.05). Conclusion This study demonstrates that symptomatic PD patients have markedly delayed transit times throughout the whole gut compared to asymptomatic PD patients and controls. The correlation between scores and transit times suggest that WMC is a less useful indicator of gastric emptying than small bowel and colonic transit. Disclosure of Interest None Declared.

Oral purgative and simethicone before small bowel capsule endoscopy

To evaluate small bowel cleansing quality, diagnostic yield and transit time, comparing three cleansing protocols prior to capsule endoscopy. Sixty patients were prospectively enrolled and randomized to one of the following cleansing protocols: patients in Group A underwent a 24 h liquid diet and overnight fasting; patients in Group B followed protocol A and subsequently were administered 2 L of polyethylene glycol (PEG) the evening before the procedure; patients in Group C followed protocol B and were additionally administered 100 mg of simethicone 30 min prior to capsule ingestion. Small bowel cleansing was independently assessed by two experienced endoscopists and classified as poor, fair, good or excellent according to the proportion of small bowel mucosa under perfect conditions for visualization. When there was no agreement between the two endoscopists, the images were reviewed and discussed until a consensus was reached. The preparation was considered acceptable if > 50% or adequate if > 75% of the mucosa was in perfect cleansing condition. The amount of bubbles was assessed independently and it was considered significant if it prevented a correct interpretation of the images. Positive endoscopic findings, gastric emptying time (GET) and small bowel transit time (SBTT) were recorded for each examination. There was a trend favoring Group B in achieving an acceptable (including fair, good or excellent) level of cleansing (Group A: 65%; Group B: 83.3%; Group C: 68.4%) [P = not significant (NS)] and favoring Group C in attaining an excellent level of cleansing (Group A: 10%; Group B: 16.7%; Group C: 21.1%) (P = NS). The number of patients with an adequate cleansing of the small bowel, corresponding to an excellent or good classification, was 5 (25%) in Group A, 5 (27.8%) in Group B and 4 (21.1%) in Group C (P = 0.892). Conversely, 7 patients (35%) in Group A, 3 patients (16.7%) in Group B and 6 patients (31.6%) in Group C were considered to have poor small bowel cleansing (P = 0.417), with significant fluid or debris such that the examination was unreliable. The proportion of patients with a significant amount of bubbles was 50% in Group A, 27.8% in Group B and 15.8% in Group C (P = 0.065). This was significantly lower in Group C when compared to Group A (P = 0.026). The mean GET was 27.8 min for Group A, 27.2 min for Group B and 40.7 min for Group C (P = 0.381). The mean SBTT was 256.4 min for Group A, 256.1 min for Group B and 258.1 min for Group C (P = 0.998). Regarding to the rate of complete examinations, the capsule reached the cecum in 20 patients (100%) in Group A, 16 patients (88.9%) in Group B and 17 patients (89.5%) in Group C (P = 0.312). A definite diagnosis based on relevant small bowel endoscopic lesions was established in 60% of the patients in Group A (12 patients), 44.4% in Group B (8 patients) and 57.8% in Group C (11 patients) (P = 0.587). Preparation with 2 L of PEG before small bowel capsule endoscopy (SBCE) may improve small bowel cleansing and the quality of visualization. Simethicone may further reduce intraluminal bubbles. No significant differences were found regarding GET, SBTT and the proportion of complete exploration or diagnostic yield among the three different cleansing protocols.

216 Improved Diagnostic Yield With Early Video Capsule Endoscopy After Diagnosis of Obscure Gastrointestinal Bleeding

asymptomatic individuals to quantify the amount of injury and attempt to determine baseline scores. Methods: Healthy volunteers were recruited for this IRB-approved study. Subjects were excluded if they had taken any NSAIDs in the two weeks prior to enrollment . Other exclusion criteria included pregnancy, implanted medical devices, a history of Crohn's disease, a previous small bowel resection, a history of anklyosing spondylitis, and gastrointestinal symptoms of diarrhea, abdominal pain or nausea. CE exams were performed after fasting and the administration of simethicone prior to capsule ingestion. All studies were read at a fixed frame rate of 7fps in a quad view. Mucosal breaks were defined as lesions with white or yellow centers and a red border. Scores were determined according to the Lewis Score. Results: 34 volunteers participated in the study (17/34 male, mean age 27 years [range 18-43]). The capsule reached the colon in 31/34 (91%) of exams. All studies were of good or excellent quality. The mean small bowel transit time was 249 minutes (range 78-404 minutes). 31/34 (91%) volunteers received a Lewis Score of zero. Three CE studies had a Lewis Score of 450 for small mucosal breaks in the first and middle tertiles of the small intestine. This score is consistent with mild mucosal injury. There were no adverse events in any of the participants. Conclusion: These results demonstrate that 9% of healthy individuals who do not use NSAIDs will have mucosal breaks on CE with Lewis Scores that do not surpass 450. The percentage of healthy volunteers with mucosal breaks is consistent with prior studies that included healthy individuals. Parameters and relative weight values used to analyze each tertile of small bowel

Effect of metoclopramide on capsule endoscopy examination: a randomized study

To investigate the effect of metoclopramide on capsule endoscopy (CE) examination. Total 116 patients referred for CE were randomized into two groups with 58 patients in each group. In treatment group patients received 10 mg metoclopramide intramuscular injection after swallowing the capsule and in control group no metoclopramide was administered. The gastric transit time, small bowel transit time, complete endoscopy rate were observed in both groups. The CE examination was completed in 51 patients of treatment group (87.9%) and 48 of control group (84.2%). Mean gastric transit time was (32.45 ± 29.63) min in treatment group and (45.81 ± 40.01)min in control group, there was significant difference between two groups (P<0.05). Mean small bowel transit time was (252.69 ± 113.29) min in treatment group and (258.75 ± 83.83) min in control group, there was no significant difference between two groups (P>0.05). Metoclopramide may reduces gastric transit time, but not effect small bowel transit time,which suggests that it might increase the likelihood of complete small-bowel examination in patients undergoing capsule endoscopy.

Intramuscular Injection of Metoclopramide Decreases the Gastric Transit Time and Does Not Increase the Complete Examination Rate of Capsule Endoscopy: A Prospective Randomized Controlled Trial

Capsule endoscopy (CE) reaches the cecum in about 80% of cases. Decreasing the gastric transit time (GTT) may increase the complete examination rate (CER). Patients (n=177) were prospectively randomized into 2 groups: the control group (n=88) and the intramuscular injection with metoclopramide (IIM) group (n=89). The OMOM CE system, which has the function of real-time monitoring, was used. The patients were injected with metoclopramide 15 minutes before swallowing the CE in the IIM group. The CE would be sent into the duodenum by gastroscopy if the GTT reached 120 minutes in the two groups. No significant difference was noted between the two groups. Of the 169 cases without gastroscopic help, the mean GTT was shorter in the IIM group (n=87) than the control group (n=82) (p=0.002). But the CER was similar. Of 135 cases without gastroscopic help but reached the cecum, the mean GTT was shorter in the IIM group (n=71) than the control group (n=64) (p=0.015). But the mean small bowel transit time (SBTT) was similar. Intramuscular injection of metoclopramide decreases the gastric transit time, but it does not change the SBTT or CER of capsule endoscopy in our study.

Prolonged Small Bowel Transit Improves Diagnostic Yield in Video Capsule Endoscopy

Purpose: Video Capsule Endoscopy (VCE) has become the preferred initial imaging modality for the small bowel (SB) with superior diagnostic yield relative to traditional imaging techniques. Much focus has been placed on hastening small bowel transit time (SBTT) in an effort to improve diagnostic yield by achieving a higher study completion rate. Only recently has evidence emerged to demonstrate improved diagnostic yield with prolonged SB transit. Here we evaluate the impact of SBTT on diagnostic yield in VCE. Methods: Exactly 409 consecutive VCE studies from a single reader at the University of California Davis Medical Center between March 2004 and March 2010 were retrospectively reviewed. All patients with incomplete bowel prep were removed. Complete and incomplete studies were isolated and evaluated separately. Results: Of the 409 patients reviewed, 356 (87%) met criteria for the study. There were 304 (85%) complete studies. The top 10% of patients with the fastest SBTT had a mean SBTT of 72 min, while those in the bottom 10% had a mean SBTT of 382 min, and all others had a mean SBTT of 220 min. Among these, there was a trend towards greater diagnostic yield with increased SBTT — 27% for SBTT 17-108 min vs 57% for SBTT 327-469 min, p = 0.04, OR 3.6 [95% (1.2 to 10.6)]. There were significantly more SB masses identified in patients with prolonged SBTT — 0% for SBTT 17-108 vs 23% for SBTT 327-469 (p = 0.01). There were 52 (15%) incomplete studies. The top 25% of patients with the fastest gastric transit time (GTT) had a mean GTT of 8 min, while those in the bottom 25% had a mean GTT of 225 min, and all others had a mean GTT of 40 min. Among these, there was an inverse relationship between GTT and diagnostic yield — 85% for GTT 2-13 min vs 38% for GTT 97-409 min, p = 0.04, OR 8.8 [95% (1.3 to 57.4)]. Conclusion: Prolonged SB transit during VCE is associated with higher diagnostic yield, possibly as a result of greater image capture by the capsule endoscope. That faster GTTs in patients with incomplete studies led to a significantly higher diagnostic yield further supports that time spent in the SB by the capsule endoscope is critical to optimizing diagnostic yield. Significantly more SB masses were identified with longer SBTT, suggesting that SB masses are more commonly missed with faster SB transit, and perhaps slowing SB transit would allow for increased detection of these lesions. Altogether, these data suggest that SBTT is a key factor in improving diagnostic yield, and perhaps efforts should be focused on hastening gastric transit and prolonging SB transit, even at the expense of incomplete studies.

PTH-039 Assessment of gastrointestinal transit time of a non-digestible solid: can the “old” wireless capsule endoscopy be as useful as the new SmartPill?

Introduction Wireless capsule endoscopy (WCE) has been used since 2001 to detect and diagnose disorders of the small intestine. SmartPill, currently only available in the US, is an innovative method used to evaluate gastrointestinal transit. This is a wireless capsule with similar dimension to WCE that uses the indirect measure of pH change to measure gastric emptying time and small bowel transit time. WCE provides pinpoint accuracy for recognising entry into the stomach, passage into the duodenal bulb and time to reach ileo-caecal valve. It seems likely that like SmartPill, WCE could be used to assess motility as well as mucosal appearance. The aim of our study was to assess gastric emptying time (GET) and small bowel transit time (SBTT) in a series of patients undergoing WCE and to compare these with published studies of SmartPill1. Methods Between January 2008 and November 2009, 301 consecutive patients had WCE in our institution; 134 patients had a normal study (59M:75F; mean age 51±17 years). In these individuals, we used WCE to measure GET and SBTT and compared the results with SmartPill data published in healthy individuals. Results In the 134 patients with a normal WCE study, indications for WCE were: iron deficiency anaemia in 73 (54%), suspected inflammatory bowel disease in 30 (23%), abdominal pain and/or diarrhoea in 24 (18%) and suspected small bowel tumour in 10 (5%). Mean GET was 36±37 minutes and mean SBTT was 238±84 min. The capsule failed to reach the ileo-caecal valve in eight patients (6%). The mean GET reported using SmartPill in healthy volunteers has been reported as 92±44 min in subjects swallowing the capsule with water, and when given with a test meal mean GET was 190±54 min and mean SBTT 332±39 min. Conclusion Highly accurate visual cues observed directly with WCE can be used to accurately measure gastric and small bowel transit times for this non-digestible solid. In our series of patient with normal WCE study, mean GET was 36 min and SBTT was 238 min. This differs substantially from recognised SmartPill values. WCE and SmartPill are insoluble and have similar size and shape; the difference in transit time measurements suggests that measurements based on pH change or direct visualisation of visual landmarks differ. The potential to use either of these capsules to assess motility requires further evaluation.

Fields of applications, diagnostic yields and findings of OMOM capsule endoscopy in 2400 Chinese patients

To retrospectively analyze the fields of application, diagnostic yields and findings of OMOM capsule endoscopy in Chinese patients. A database including 2400 Chinese patients who received OMOM capsule endoscopy in 27 endoscopy centers in China was retrieved from the Jianshan Science and Technology Ltd. OMOM capsule endoscopy database. The patient's age, gender, fields of application, the potentially relevant findings, pyloric transit time (PTT), small bowel transit time (SBTT), and complete small-bowel examination rate (CSER) were recorded and analyzed. Two thousand four hundred patients aged 9-91 years (mean, 49 years), of whom 1510 were males (62.9%), underwent 2400 OMOM capsule endoscopy procedures. One thousand two hundred and thirty two (51.3%) were referred with obscure gastrointestinal bleeding (OGIB), 642 (26.8%) with abdominal pain, and 223 (9.3%) with chronic diarrhea. The overall diagnostic yield was 47.7% (1144/2400). The diagnostic yield of OMOM capsule endoscopy in OGIB subgroup was much higher than in the non-OGIB subgroup (62.4% vs 32.1%, P < 0.001). The most common findings of the small bowel in Chinese patients with OGIB were arteriovenous malformation (28.1%) and tumors (18.9%). There was no significant difference in the diagnostic yield between the male and female patients with OGIB. However, the diagnostic yield in patients aged more than 60 was higher than in patients aged less than 60 (69.8% vs 58.9%, P < 0.001). The median PTT was 41 min (range: 1-544 min) and the mean SBTT was 247.2 +/- 88.9 min. The overall CSER was 86.8%. The OMOM capsule endoscopy is a valuable tool for small bowel evaluation with good overall diagnostic yield and CSER.

Prospective controlled study of effect of laparoscopic sleeve gastrectomy on small bowel transit time and gastric emptying half-time in morbidly obese patients with type 2 diabetes mellitus

Background Published data on sleeve gastrectomy (SG) have indicated better remission of type 2 diabetes mellitus (T2DM) and improvement in satiety compared with other restrictive procedures. Mechanisms in addition to rapid, extensive weight loss are responsible for the restoration of the euglycemic state. To prospectively evaluate the role of laparoscopic SG on gastric emptying half-time and small bowel transit time (SBTT) and effect of these on weight loss, satiety, and improvement in T2DM. Methods A total of 67 subjects were studied. Of these 67 subjects, 24 were lean controls (body mass index 22.2 ± 2.84 kg/m 2), 20 were severely and morbidly obese patients with T2DM who had not undergone SG (body mass index 37.73 ± 5.35 kg/m 2), and 23 were severely and morbidly obese patients with T2DM after SG (body mass index 40.71 ± 6.59 kg/m 2). All 67 patients were evaluated for gastric emptying half-time and SBTT using scintigraphic imaging. Imaging was performed every 15 minutes up to the ileocecal region. The Three-Factor Eating Questionnaire was administered simultaneously. Fasting blood sugar, postprandial blood sugar, and glycated hemoglobin were assessed. Nonparametric analysis of variance and the Mann-Whitney U test were applied. Results The mean SBTT was significantly lower ( P <.05) in the post-SG group (199 ± 65.7 minutes) than in the non-SG group (281.5 ± 46.2 minutes) or control group (298.1 ± 9.2 minutes). The gastric emptying half-time values were also significantly shorter ( P <.05) in the post-SG (52.8 ± 13.5 minutes) than in the non-SG (73.7 ± 29.0 minutes) and control (72.8 ± 29.6 minutes) groups. The glycated hemoglobin, fasting blood sugar, and postprandial sugar were all significantly lower after SG. The Three-Factor Eating Questionnaire findings revealed significantly earlier satiety (29.0 ± 7.2) for the post-SG patients ( P <.05) compared with the non-SG (45.8 ± 9.0) and control (37.9 ± 6.2) subjects. Conclusion A decreased gastric emptying half-time and SBTT after SG can possibly contribute to better glucose homeostasis in patients with T2DM.

Lubiprostone neither decreases gastric and small-bowel transit time nor improves visualization of small bowel for capsule endoscopy: a double-blind, placebo-controlled study

Lubiprostone, a selective activator of type 2 chloride channels, is approved for treatment of chronic idiopathic constipation and recently constipation-predominant irritable bowel syndrome. It has been suggested that lubiprostone has a prokinetic effect. This investigation was designed to evaluate lubiprostone as a preparation and propulsive agent for small-bowel capsule endoscopy. The PillCam Small Bowel capsule endoscopy system with the PillCam SB1 capsule and Rapid 5 software platform were used. The study was designed as a double-blind, placebo-controlled trial. Forty healthy adults. Gastric transit time (GTT), small-bowel transit time (SBTT), and adequacy of small-bowel cleansing preparation. The study subjects received 24 mug lubiprostone or placebo 30 minutes before PillCam capsule ingestion. Capsule endoscopy studies were read by 2 independent investigators unaware of the study medication received, and differences in interpretation were resolved by consensus. Anatomical landmarks were identified, and GTT and SBTT were calculated. Overall preparation quality assessment of the proximal, mid, and distal small bowel was determined by using a 4-step scale. The percentage of visualized bowel was determined by review of 10-minute video segments at 1-hour intervals after the capsule passed through the pylorus. In the lubiprostone group (n = 20), 2 subjects did not pass the capsule through the pylorus in the 8-hour battery life of the capsule. An additional 3 capsules did not pass into the colon. In the placebo group (n = 20), all capsules passed into the small bowel, but 1 did not pass into the colon. The subjects in whom the capsule did not pass into the small bowel were excluded from the small-bowel analysis. In the subjects in whom the capsule did reach the colon, the SBTT could not be calculated and they were excluded from SBTT analysis. The mean GTT in the lubiprostone group was 126 minutes and 43 minutes in the placebo group (P = .0095). The mean SBTT in the lubiprostone group was 188 minutes and 219 minutes in the placebo group (P = .130). The overall preparation assessment of the small bowel was not statistically significant between the 2 groups in the proximal, mid, or distal small bowel (proximal, P = .119; mid, P = .118; distal, P = .121). There was no significant difference in lubiprostone compared with placebo in the percentage of visualized small bowel. Some capsules did not leave the stomach or reach the cecum. Lubiprostone produced a significant increase in GTT but did not result in a significant decrease in SBTT compared with placebo. The administration of lubiprostone before capsule ingestion did not result in improved overall preparation of the small bowel for capsule endoscopy or increase the percentage of visualized small bowel. (The trial was registered at www.clinicaltrials.gov, identifier NCT00746395.).

The Effect of Metoclopramide in Capsule Enteroscopy

Clinical utility of prokinetics in capsule endoscopy (CE) is not clearly established. The objective of this prospective, randomized, single-blind, controlled trial was to determine if metoclopramide is useful in CE by increasing the rate of complete enteroscopy. Ninety-five patients referred for CE were randomized to no metoclopramide (group B, n = 48) or 10 mg metoclopramide (group A, n = 47). Complete enteroscopy was possible in 38 patients of group A (80.9%) and 37 of group B (77.1%) (P = 0.422) with two cases of gastric retention in group B (4.2%; P = 0.253). Median gastric transit time was 26 min (1-211) in group A and 28 min (4-200) in group B (P = 0.511). Mean small bowel transit time, calculated after excluding 20 patients with incomplete enteroscopy, was similar in both groups (221.2 +/- 89 min vs. 256 +/- 82.2 min; P = 0.083). There were also no differences in the total number of findings (group A 4.5 +/- 4.7; group B 4.7 +/- 3.7, P = 0.815). Administration of 10 mg metoclopramide orally 15 min before capsule ingestion did not significantly increase the rate of total enteroscopies and had no effect on transit times. It also did not modify CE diagnostic yield.

Does Lubiprostone Decrease Gastric and Small Bowel Transit Time and Improve Visualization of Small Bowel with Capsule Endoscopy?

Purpose: Lubiprostone, a selective activator of type 2 chloride channels, is approved for treatment of chronic idiopathic constipation and constipation predominant IBS. It has been suggested that lubiprostone has a prokinetic effect. This investigation was designed to evaluate lubiprostone as a preparation and propulsive agent for small bowel capsule endoscopy. Methods: The PillCam Small Bowel (SB) capsule endoscopy system (Given Imaging, Yoqneam, Israel) utilizing the PillCam SB1 capsule and Rapid 5 software platform was used. The study was designed as a double blinded placebo-control trial in 40 healthy adults to compare gastric transit time (GTT), small bowel transit time (SBTT), and small bowel cleansing preparation. The study subjects received lubiprostone 24 mcg or placebo 30 minutes prior to PillCam capsule ingestion. Capsule endoscopy studies were read by two independent investigators unaware of the study medication received and differences in interpretation were resolved by consensus. Anatomical landmarks were identified and GTT and SBTT were calculated. Overall preparation assessment of the proximal, mid, and distal small bowel was determined by a 4 step scale. Percentage of visualized bowel was determined by review of 10 minute video segments at 1 hr intervals after the capsule passed through the pylorus. Results: In the lubiprostone group (N = 20), 2 subjects did not pass the capsule through the pylorus in the 8 hr battery time of the capsule. An additional 3 capsules did not pass into the colon. In the placebo group (N = 20), all capsules passed into the small bowel, but 1 did not pass into the colon. The subjects in which the capsules did not pass into the small bowel were excluded from the small bowel analysis. In the subjects that the capsules did not reach the colon, the SBTT was determined by total number of minutes subtracted from the gastric emptying time for each subject. The mean GTT in the lubiprostone group was 126 minutes and 43 minutes in the placebo group (P= 0.0095). The mean SBTT in the lubiprostone group was 208 minutes and 228 minutes in the placebo group (P= 0.249). The overall preparation assessment of the small bowel was not statistically significant between the 2 groups in the proximal, mid or distal small bowel (p- = 0.119-proxmial, 0.118-mid, 0.121-distal). There was no significant difference in lubiprostone vs. placebo in the percentage of visualized small bowel. Conclusion: Lubiprostone had a significant increase in GTT but did not result in a significant decrease in SBTT as compared to placebo. The administration of lubiprostone prior to capsule ingestion did not result in improved overall preparation of the small bowel for capsule endoscopy or increase the percentage of visualized small bowel.

Enhanced Diagnostic Yield with Increased Small Bowel Transit Time During Capsule Endoscopy

Background: The use of promotility agents has been advocated in capsule endoscopy (CE) to increase the rate of intestinal transit time and assure complete visualization over the allotted lifetime of the battery. The effect of small bowel transit time (SBTT) on diagnostic yield, however, has not been evaluated on a large-scale basis. Aim: To assess the effect of SBTT on the ability of CE to detect significant intestinal pathology in a large cohort of patients. Methods: Data were collected prospectively on patients undergoing CE without the use of promotility agents at Johns Hopkins Hospital between January 2006 and June 2007. In patients investigated for anemia or obscure GI bleeding, the following lesions were considered clinically relevant: ulcers, erosions, AVMs, red spots, varices, vascular ectasias, and fresh blood. For those with diarrhea or abdominal pain, only ulcers, erosions, and fresh blood were considered relevant. SBTT was divided into 2-hr intervals between 0-8 hr. Age, gender, indication, inpatient vs. outpatient status, and bowel prep (poor/average/good) were identified as candidate risk factors affecting SBTT. Univariate and bivariate logistic regression analysis was performed to study the effect of SBTT on diagnostic yield. Results: Data were analyzed in 212 patients undergoing CE for 4 different indications (anemia = 42, obscure GI bleeding = 78, diarrhea = 38, pain = 54). Most studies were performed in outpatients (n = 175, 83%); ∼70% of capsules reached the cecum. Mean SBTT overall was 237.0 min (3.9 hr). Age, gender, bowel prep, inpatient status, and study indication did not significantly affect SBTT. Increased SBTT was independently associated with increased diagnostic yield; compared to SBTT = 0-2 hr, patients with SBTT = 2-4 hr (OR = 1.7, p = 0.4), 4-6 hr (OR = 1.8, p = 0.3), and 6-8 hr (OR = 9.6, p = 0.05) were more likely to have a clinically significant finding on CE. In each category of SBTT, >80% patients were reported to have a “good” bowel prep. Conclusion: Prolonged SBTT during CE (>6 hr) is associated with an increased diagnostic yield. This finding does not appear to be related to the quality of the bowel prep, and may be due to a positive effect on image quality during a “slower” study. The use of promotility agents may adversely affect the ability of CE to detect significant intestinal pathology.

Enhanced diagnostic yield with prolonged small bowel transit time during capsule endoscopy.

The effect of small bowel transit time (SBTT) on diagnostic yield during capsule endoscopy (CE) has not been previously evaluated. Our study aim was to assess the effect of SBTT on the likelihood of detecting intestinal pathology during CE. We reviewed collected data on CE studies performed at Johns Hopkins Hospital from January 2006 to June 2007. In patients investigated for anemia or obscure bleeding, the following lesions were considered relevant: ulcers, erosions, AVMs, red spots, varices, vascular ectasias, and presence of blood. In patients with diarrhea or abdominal pain, ulcers, erosions, and blood were considered relevant. Age, gender, study indication, hospital status, and quality of bowel preparation were identified as candidate risk factors affecting SBTT. Univariate logistic and linear regression analyses were performed to study the effect of SBTT on diagnostic yield. Total of 212 CE studies were analyzed; most were in outpatients (n=175, 82.9%) and with excellent bowel preparation (n=177, 83.5%). Mean SBTT was 237.0 min (3.9 hrs). Age, gender, bowel prep, hospital status, and study indication did not significantly affect SBTT. However, increased SBTT was independently associated with increased diagnostic yield; OR=1.7 in SBTT=2-4 hr (p=0.41), OR=1.8 in SBTT=4-6 hrs (p=0.30), OR=9.6 in SBTT=6-8 hrs (p=0.05). Prolonged SBTT during CE (>6 hr) is associated with an increased diagnostic yield. This may be due to a positive effect on image quality during a "slower" study. The use of promotility agents may adversely affect the ability of CE to detect significant intestinal pathology.

Factors Affecting Capsule Endoscopy Transit Time

Backgroud: Efficacy of capsule endoscopy depends on the propulsion of the capsule by gastrointestinal peristalsis. Patient demographics, comorbid conditions and medications affect peristalsis and have an impact on capsule endoscopy transit times and results of the study. Aim: To study the effect of patient factors on capsule endoscopy transit times (CETT). Methods: The study is a retrospective analysis of patients who underwent capsule endoscopy from 2005 to 2006 at a tertiary care hospital in Philadelphia. Data gathered included patient demographics (age, gender, BMI), indications for capsule endoscopy, comorbid conditions (diabetes, hypothyroidism, gastroesophageal reflux disease), medications (calcium channel blockers, senna, proton pump inhibitors) and capsule transit times. Normal esophageal and gastric transit times were defined as less than thirty seconds and three hours respectively. Factors that could delay transit times were evaluated and compared using the Mann-Whitney U test. Results: Fifty four patients had capsule endoscopy performed for various indications (anemia-69%, occult GI bleeding-33%, change in bowel habits-7%). Mean esophageal transit time (ETT) was 8 seconds (n = 38). Sixteen patients were excluded from this calculation based on prolonged ETT. Out of 54 patients, 2 had prolonged gastric transit time (GTT) and the capsule never entered the small bowel. Among patients with normal GTT, mean transit time was 24 minutes. The mean small bowel transit time (SBTT) was 240 minutes. Five capsules did not enter the small bowel and four did not enter the colon. The GTT and SBTT could not be calculated in these patients. Only one patient required surgical removal for retained capsule. Fifty seven percent of the patients were older than 65 years. When compared with patients younger than 65 years, they had a significantly shorter GTT (p = 0.03). Gender, body mass index, diabetes, gastroesophageal reflux disease and use of medications (calcium channel blockers, proton pump inhibitors and senna) had no effect on CETT. Seventeen percent of the patients (n = 9) had hypothyroidism. Patients with hypothyroidism had a statistically significant prolonged small bowel transit time (p = 0.04) when compared to those without hypothyroidism. There was no difference when ETT and GTT were compared in this subgroup. Conclusions: This study demonstrates that CETT is affected by age and hypothyroidism. These factors have to be considered when interpreting CE results. Diabetes and use of calcium channel blockers do not effect capsule endoscopy transit time. Further studies are needed to better define independent risk factors for delayed capsule transit.