Audit of the Use of Prokinetics to Improve Completion Rates of Small Bowel Capsule Endoscopy

Aims Prolonged gastric transit has been recognized as a risk factor for incomplete small bowel capsule endoscopy (SBCE). ESGE suggests patients with increased risk may benefit from the administration of prokinetics when the capsule remains in the stomach for > 30 – 60 minutes. Gastric transit is routinely assessed in at risk subjects at 30 minutes in our unit. IV Metoclopramide 10mg is given as an initial prokinetic, and 250mg IV Erythromycin as a second prokinetic after a further 30 minutes if required.

Aim To assess the efficacy of prospective gastric transit assessment and intervention.

Methods A retrospective analysis of SBCE’s performed since the introduction of prospective gastric passage assessment in at risk patients from April 2020 to present in our unit. Basic demographics, procedure outcomes and prokinetic usage was recorded. Comparison was made with age and gender matched controls without delayed gastric emptying in a 2:1 ratio.

Results In all, 400 procedures were included, 13.25 % (n = 53) received a prokinetic; 45 (85 %) received a single prokinetic, with 8 (15 %) receiving a second. Demographics were similar to controls (n = 106), mean age 55 vs 57 years and 51 % vs 49 % male. The small bowel transit time in the prokinetic group was faster than controls, (193 versus 228 minutes, p=0.01. However, completion rates (90.2 % (n = 48) vs 96.25 % (n = 102)) and rates of significant findings (37.7 % (n = 20) vs 32.5 % (n = 34)) were similar. No capsules were retained. There were no serious adverse events (SE) in the prokinetic group, but 4 (7 %) reported any SE including nausea, dizziness and pain at the cannula site.

Conclusions In patients at risk of incomplete SBCE as a result of delayed gastric emptying assessment of gastric transit and administration of prokinetics if required is effective. A significant (15 %) proportion require a second prokinetic increasing the potential for adverse events. Alternative prokinetic interventions would be advantageous.

Citation O’Hara F, Seminov S, McNamara D eP103 AUDIT OF THE USE OF PROKINETICS TO IMPROVE COMPLETION RATES OF SMALL BOWEL CAPSULE ENDOSCOPY. Endoscopy 2021; 53: S130.

Publication History

Article published online:
19 March 2021