Original Article
Complete small-bowel transit in patients undergoing capsule endoscopy: determining factors and improvement with metoclopramide

https://doi.org/10.1016/S0016-5107(04)02462-9Get rights and content

Background

Passage of the capsule endoscope to the colon occurs in only approximately three quarters of patients. This study assessed factors that might influence the completeness of small-bowel transit, including orally administered metoclopramide.

Methods

Clinical and procedural parameters were recorded prospectively for 150 patients undergoing capsule endoscopy. Metoclopramide was not administered to the first 83 patients (Group 1) but was given orally (10 mg) to the subsequent 67 (Group 2).

Results

Small-bowel transit was complete in 63 patients in Group 1 (76%). Gastric transit time was significantly longer when the capsule did not reach the colon than when it did (114.9 ± 32.6 minutes vs. 26.6 ± 2.9 minutes; p = 0.007). Small-bowel transit time also was longer. The likelihood of complete small-bowel passage was not predicted by any clinical or procedural factor. In Group 2 (metoclopramide), the capsule reached the colon in 65 (97%) patients (OR 10.3: 95% CI[2.32, 93.55], p < 0.001). This improvement was associated with a significant reduction in gastric transit time (47.9 ± 9.0 minutes vs. 30.8 ± 7.5 minutes; p = 0.025).

Conclusions

Metoclopramide increases the likelihood of a complete small-bowel examination in patients undergoing capsule endoscopy.

Section snippets

Patients

A total of 157 patients underwent CE between May 2001 and December 2003. Indications included the following: obscure GI bleeding (119 patients); known or suspected small-bowel disease, including Crohn's disease (19); and abdominal pain (19) (Table 1). All patients had been referred for CE. Clinical and procedural parameters recorded prospectively, as well as findings at CE, are shown in Table 1.

Seven patients were excluded from analysis, because passage of the capsule was either delayed or

Group 1

The small intestine was examined completely in 63 of the 83 patients (76%) not given metoclopramide. In the 20 patients with an incomplete examination, the capsule remained in the stomach in two and in the small intestine in 18. In one of the latter patients, there also was considerable delay in the esophagus (351 minutes before capsule entered stomach), although the patient had no history or symptoms of esophageal dysfunction.

Gastric transit time was significantly longer in patients in whom

Discussion

This study has two important findings: (1) complete small-bowel transit occurs in only about three quarters of patients undergoing CE without a prokinetic agent, and (2) administration of metoclopramide significantly increases the likelihood of capsule transit through the entire small intestine. In the 83 patients who did not receive metoclopramide (Group 1), the most striking difference between those in whom the capsule did or did not reach the colon was the significantly longer time that the

Acknowledgment

Associate Professor Kai Lo provided statistical consultation for this study and his support is acknowledged.

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Presented at the Third International Conference on Capsule Endoscopy, February 29-March 3, 2004, Miami, Florida.

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