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

ABSTRACT: 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.

SUBMITTER: O'Grady J

PROVIDER: S-EPMC7035031 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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

O'Grady John J Murphy Clodagh L CL Barry Lillian L Shanahan Fergus F Buckley Martin M

Endoscopy international open 20200221 3

<b>Background and study aims</b> 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 ...[more]

PMID: 32118112

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Project description:BackgroundVideo capsule endoscopy (VCE) is a commonly used test for the evaluation of obscure gastrointestinal bleeding. However, long-term outcomes of patients undergoing VCE are unclear.AimsTo evaluate the long-term outcomes in patients undergoing VCE for suspected obscure bleeding including iron deficiency anemia (IDA), and determine the need for additional intervention for persistence or recurrence of symptoms in patients with a diagnostic as well as non-diagnostic VCE.DesignRetrospective cohort study within a large county hospital system.MethodsWe collected information on indications and findings of VCE and outcomes including further testing, bleeding, and hemoglobin (Hgb) at last follow-up through structured review of the electronic health records. VCE findings were classified as active bleeding or high potential for bleeding (P2), intermediate potential (P1) or without any disruption of the mucosa, and no potential for bleeding (P0). We compared demographic and clinical characteristics between patients with and without normal Hgb at the time of last follow up.ResultsWe examined 116 patients who underwent VCEs performed for obscure gastrointestinal (GI) bleeding during 2010 to 2012 with mean duration of follow up after VCE completion of 571 days (standard deviation [SD]?=?248). Abnormal VCE findings (37.9% for P1 lesions, 44.8% for P2 lesions) were seen in 106 (87.9%) patients. Additional diagnostic testing was performed in 55/116 (47.4%) (67.7% GI procedures). Hgb was restored to normal range in 59/116 (50.9%) by end of follow up which were attributed to iron supplementation and/or discontinuation of non-steroidal anti-inflammatory drugs (NSAIDs) in a majority. Twenty six of 116 patients experienced rebleeding (22.4%).ConclusionsThe diagnostic yield of VCE is high among patients with obscure GI bleeding. More than 50% of patients achieve normal Hgb in the long term with conservative measures such as iron supplementation and the discontinuation of NSAIDs.

Project description:Abstract Background Small bowel capsule endoscopy (CE) has limited recording time and does not visualize the entire length of the small intestine in approximately 16.5% of the cases. We hypothesize that bacon-chewing is potent stimulus of cephalic response, which may reduce capsule transit times and improve complete examination rate (CER). Aims To determine if sham feeding with bacon-chewing improves small bowel transit time and completion rate in patients undergoing capsule endoscopy. Methods A prospective, single-blinded, randomized controlled trial at St. Paul’s Hospital in Vancouver, BC has been recruiting since 01/2015. Inclusion: outpatient CE, age ≥ 19. Exclusion criteria: ongoing use of motility-enhancing or slowing drugs, active bowel obstruction, bowel resection, swallowing disorder, diabetes with end-organ damage, untreated thyroid disorder, and endoscopic placement of capsule camera. Given Imaging PillCam SB3TM (Yoqneam, Israel) were used. Participants were assigned to either bacon or control group via concealed allocation based on unrestricted randomization sequence generated prior to study initiation. All subjects underwent bowel preparation with 2L PEG3350 with electrolytes the day before, and fasted ≥ 2h prior to the procedure. They were allowed to drink clear fluids and resume normal diet 2h and 4h post-capsule ingestion, respectively. Immediately after swallowing the capsule, subjects in the bacon group were asked to chew and spit 10 pieces of bacon, each over 30 seconds at one-minute intervals. This process was repeated an hour after ingesting the capsule. Gastric transit time (GTT), small bowel transit time (SBTT), and CER were compared between the groups. This study was approved by institutional research ethics board and registered on clinicaltrials.gov (NCT02353208). Results Between 01/2015 to 09/2016, 109 CE’s were included in the study, 89 of which were for GI bleeding. CE did not pass the pylorus in four patients in the bacon group during the recording, and were excluded from further transit time analyses. One and two additional CE’s in the control and bacon group, respectively, did not reach cecum during recording and were excluded from SBTT analysis. There was no statistically significant difference in GTT, SBTT, or CER. Conclusions Sham feeding by chewing and spitting bacon does not alter transit times or CER, and therefore should not be used in an attempt to improve CE yield. ResultsControl (n=54)Bacon (n=55)P valueAge (mean ± SD)57.2 ± 15.657.9 ± 17.50.83Female (%)30 (55.6%)30 (54.5%)0.92Charlson Comorbidity Index3.4 ± 2.43.3 ± 2.80.99GTT (minutes)mean ± SDmedian (IQR)41.4 ± 47.224.7 (13.9, 55.7)56.7 ± 126.517.2 (10.3, 68.6)0.20SBTT (minutes)mean ± SDmedian (IQR)230.0 ± 106.2217.6 (157.4, 282.3)223.1 ± 128.5198.5 (119.6, 294.8)0.38CER (%)53 (98.1%)49 (89.1%)0.054 Funding Agencies None

Project description:ImportanceEvaluation of acute gastrointestinal (GI) bleeding using invasive endoscopic procedures comprising the standard of care (SOC)-upper endoscopy and colonoscopy-can expose the endoscopy staff to SARS-CoV-2. Video capsule endoscopy (VCE) does not generate aerosols and only requires 1 person to manage the procedure.ObjectiveTo examine the safety of VCE for the initial evaluation of GI bleeding at the peak of the COVID-19 pandemic to identify signs of active bleeding while minimizing patient and personnel exposure, saving personal protective equipment, and avoiding invasive or unnecessary procedures.Design, setting, and participantsA multicenter (UMass Memorial Medical Center and Louisiana State University Health Sciences Center) retrospective cohort study including 146 patients with COVID-19 who received VCE as the first-line diagnostic modality was conducted from March 15 to June 15, 2020, compared with SOC in January 2020 for evaluation of GI bleeding. The association between treatment and outcomes was estimated using multivariable regression adjusting for potential confounders. Propensity score matching was used to verify the results.Main outcomes and measuresThe primary end point was detection of active bleeding or stigmata of recent bleeding. Secondary end points included the number of patients requiring any invasive procedures, number of additional procedures, rates of rebleeding and rehospitalization, transfusion requirements, and mortality.ResultsAmong 146 patients, 92 (63.0%) were men; mean (SD) age was 64.93 (14.13) years in the COVID-19 group and 61.33 (13.39) years in the SOC group. Active bleeding or stigmata of recent bleeding was observed in 44 (59.5%) patients in the COVID-19 group compared with 18 (25.0%) in the SOC group (adjusted odds ratio, 5.23; 95% CI, 2.23 to 12.27). Only 36 patients (48.7%) in the COVID-19 group required any invasive procedure during the hospitalization compared with 70 (97.2%) in the SOC group (adjusted odds ratio, 0.01; 95% CI, 0.001 to 0.08). The mean (SD) number of invasive procedures was 0.59 (0.77) per patient in the COVID-19 group compared with 1.18 (0.48) per patient in the SOC group (adjusted difference, -0.54; 95% CI, -0.77 to -0.31). Both approaches appeared to be safe and there was no significant difference in transfusion requirements, rebleeding, rehospitalization, or in-hospital mortality. No mortality was attributed to GI bleeding in either group.Conclusions and relevanceIn this cohort study, first-line diagnostic evaluation of acute GI bleeding using VCE appeared to be a safe and useful alternative to the traditional approach of upper endoscopy and colonoscopy. Use of VCE was associated with increased detection of active bleeding and a reduced number of invasive procedures and unnecessary exposure of personnel to SARS-CoV-2 and use of personal protective equipment.

Dataset Information

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

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

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