Brief Article
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World J Gastrointest Endosc. Dec 16, 2013; 5(12): 595-599
Published online Dec 16, 2013. doi: 10.4253/wjge.v5.i12.595
Finding the solution for incomplete small bowel capsule endoscopy
José Cotter, Francisca Dias de Castro, Joana Magalhães, Maria João Moreira, Bruno Rosa
José Cotter, Francisca Dias de Castro, Joana Magalhães, Maria João Moreira, Bruno Rosa, Gastroenterology Department, Centro Hospitalar do Alto Ave, 4835-044 Guimarães, Portugal
José Cotter, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057 Braga/Guimarães, Portugal
José Cotter, ICVS/3B’s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
Author contributions: Cotter J developed and coordinated the study, drafted and critically revised the manuscript and approved the final version to be submitted; Dias de Castro F reviewed the capsule endoscopy videos, performed data analysis and literature research and drafted the manuscript; Magalhães J participated in the design of the study and statistical analysis; Moreira MJ and Rosa B revised the manuscript and reviewed the capsule endoscopy videos; all the authors read and approved the final manuscript.
Correspondence to: José Cotter, MD, Gastroenterology Department, Centro Hospitalar do Alto Ave, Rua dos Cutileiros, 4835-044 Guimarães, Portugal. jcotter@chaa.min-saude.pt
Telephone: +351-253-540330 Fax: +351-253-421308
Received: September 14, 2013
Revised: November 1, 2013
Accepted: November 15, 2013
Published online: December 16, 2013
Processing time: 98 Days and 12.2 Hours
Abstract

AIM: To evaluate whether the use of real time viewer (RTV) and administration of domperidone to patients with delayed gastric passage of the capsule could reduce the rate of incomplete examinations (IE) and improve the diagnostic yield of small bowel capsule endoscopy (SBCE).

METHODS: Prospective single center interventional study, from June 2012 to February 2013. Capsule location was systematically checked one hour after ingestion using RTV. If it remained in the stomach, the patient received 10 mg domperidone per os and the location of the capsule was rechecked after 30 min. If the capsule remained in the stomach a second dose of 10 mg of domperidone was administered orally. After another 30 min the position was rechecked and if the capsule remained in the stomach, it was passed into the duodenum by upper gastrointestinal (GI) endoscopy. The rate of IE and diagnostic yield of SBCE were compared with those of examinations performed before the use of RTV or domperidone in our Department (control group, January 2009 - May 2012).

RESULTS: Both groups were similar regarding age, sex, indication, inpatient status and surgical history. The control group included 307 patients, with 48 (15.6%) IE. The RTV group included 82 patients, with 3 (3.7%) IE, P = 0.003. In the control group, average gastric time was significantly longer in patients with IE than in patients with complete examination of the small bowel (77 min vs 26 min, P = 0.003). In the RTV group, the capsule remained in the stomach one hour after ingestion in 14/82 patients (17.0%) vs 48/307 (15.6%) in the control group, P = 0.736. Domperidone did not significantly affect small bowel transit time (260 min vs 297 min, P = 0.229). The capsule detected positive findings in 39% of patients in the control group and 49% in the RTV group (P = 0.081).

CONCLUSION: The use of RTV and selective administration of domperidone to patients with delayed gastric passage of the capsule significantly reduces incomplete examinations, with no effect on small bowel transit time or diagnostic yield.

Keywords: Small bowel capsule endoscopy; Prokinetic drugs; Domperidone; Incomplete examination

Core tip: Incomplete small bowel capsule endoscopy (SBCE) is an important limitation of the technique and may occur in up to 20% of patients. Delayed gastric passage of the capsule is a major factor leading to incomplete SBCE. Selective administration of oral domperidone to patients with delayed gastric passage of the capsule assessed with the real time viewer (RTV) effectively reduces the rate of incomplete SBCE. The administration of domperidone does not influence small bowel transit time of the capsule. There is an overall trend towards higher diagnostic yield of SBCE when domperidone is selectively administered. The use of the RTV should be adopted systematically in patients undergoing small bowel capsule endoscopy.