Right lateral position improves complete examination rate of capsule endoscope: a prospective randomized, controlled trial

Background and study aims: In 20 % of patients, capsule endoscopes fail to reach the cecum within the 8-hour battery life. This is the most common cause of incomplete small-bowel examination. The aim of this study was to determine whether keeping patients in the right lateral position (RLP) improves the complete examination rate (CER) of the small bowel by reducing the gastric transit time (GTT) of the capsule.

Patients and methods: Patients were randomized into the RLP group (n = 30) or control group (n = 30). Patients in the RLP group were instructed to lie on their right side postingestion until the capsule had passed through the pylorus. The patients in the control group were free to walk or sit (upright position). The main outcomes were the CER and GTT between the groups.

Results: There was no significant difference in the sex, mean age, and indications between the two groups. The CER was significantly higher in the RLP group than in the controls (96.7 % vs. 73.3 %, P = 0.030). GTT was significantly shorter in the RLP group than in the control group (medians [range]: 32 [8-108] vs. 58 [9-208] minutes, P = 0.007). Small-bowel imaging time was significantly longer in the RLP group than in the control group (372 [135-425] vs. 292 [146-422] minutes, P = 0.039). There were no significant differences in the diagnostic yields between the two groups.

Conclusions: Placing patients in the RLP after ingestion of the capsule endoscope and before the capsule enters the pylorus is a simple method to increase the CER of the small bowel by reducing the GTT of the capsule.

References

• 1 Mishkin D S, Chuttani R, Croffie J. et al., . ASGE Technology Status Evaluation Report: wireless capsule endoscopy.  Gastrointest Endosc. 2006;  63 539-545
• 2 Rastogi A, Schoen R E, Slivka A. Diagnostic yield and clinical outcomes of capsule endoscopy.  Gastrointest Endosc. 2004;  60 959-964
• 3 Rondonotti E, Herrerias J M, Pennazio M. et al . Complications, limitations, and failures of capsule endoscopy: a review of 733 cases.  Gastrointest Endosc. 2005;  62 712-716
• 4 Leung W K, Chan F K, Fung S S. et al . Effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy.  World J Gastroenterol. 2005;  11 4865-4868
• 5 Caddy G R, Moran L, Chong A K. et al . The effect of erythromycin on video capsule endoscopy intestinal-transit time.  Gastrointest Endosc. 2006;  63 262-266
• 6 Wei W, Ge Z Z, Lu H. et al . Effect of mosapride on gastrointestinal transit time and diagnostic yield of capsule endoscopy.  J Gastroenterol Hepatol. 2007;  22 1605-1608
• 7 Li Z S, Liao Z, Ye P, Wu R P. Dancing hookworm in the small bowel detected by capsule endoscopy: a synthesized video.  Endoscopy. 2007;  39 E97
• 8 Lewis B. Capsule endoscopy - transit abnormalities.  Gastrointest Endosc Clin N Am. 2006;  16 221-228
• 9 Ben-Soussan E, Savoye G, Antonietti M. et al . Factors that affect gastric passage of video capsule.  Gastrointest Endosc. 2005;  62 785-790
• 10 Dunnigan M, Fenkel J M, Miller R R, Goldberg E M. Incomplete small bowel examination during wireless capsule endoscopy is more common in inpatients.  Gastrointest Endosc. 2007;  65 AB165
• 11 Triantafyllou K, Kalantzis C, Papadopoulos A A. et al . Video-capsule endoscopy gastric and small bowel transit time and completeness of the examination in patients with diabetes mellitus.  Dig Liver Dis. 2007;  39 575-580
• 12 Alim S, Matin A, Man M, Kroser J. Factors affecting capsule endoscopy transit time.  Gastrointest Endosc. 2007;  65 AB344
• 13 Fireman Z, Mahajna E, Fish L. et al . Effect of erythromycin on gastric and small bowel time of video capsule endoscopy.  Gastrointest Endosc. 2003;  57 AB162
• 14 Coumaros D, Claudel L, Levy P, Doffoel M. Diagnostic value of capsule endoscopy in obscure digestive bleeding (OBD) and effect of erythromycin injection.  Gastrointest Endosc. 2004;  59 AB177
• 15 Fireman Z, Paz D. Capsule endoscopy: improving the transit time and image view.  Gastrointest Endosc. 2004;  59 AB173
• 16 Fireman Z, Paz D, Kopelman Y. Capsule endoscopy: improving transit time and image view.  World J Gastroenterol. 2005;  11 5863-5866
• 17 Selby W. Complete small bowel transit in patients undergoing capsule endoscopy: determining factors and improvement with metoclopramide.  Gastrointest Endosc. 2005;  61 80-85
• 18 Valenzuela G A, Fugman J. Tegaserod accelerates capsule endoscopy transit compared to metoclopramide.  Gastrointest Endosc. 2007;  65 AB331
• 19 Sachdev R, Hibberd P, Mammen A, Cave D R. Reduction of gastric transit time of video capsule endoscopy by right lateral positioning.  Gastrointest Endosc. 2004;  59 AB176
• 20 Pattullo V, Walsh A, Appleyard M N, Heap T T. The effect of right lateral posturing on gastric transit time and complete small bowel transit in patients undergoing video capsule endoscopy.  Gastrointest Endosc. 2007;  65 AB165