Can steerable capsule endoscopy enhance gastric emptying?

• Research type

  Research Study

• Full title

  Randomised comparison of a standard protocol using metoclopramide versus a hand held magnet to enhance gastric emptying of the small bowel capsule.

• IRAS ID

  138893

• Contact name

  ME McAlindon

• Contact email

  mark.mcalindon@sth.nhs.uk

• Research summary

  Small bowel wireless capsule endoscopy is the investigation modality of choice for suspected diseases of the small bowel. The procedure is safe and non-invasive, the main risk being capsule retention occurring in approximately 2% of procedures. Other problems such as incomplete examinations occur in 10-20% of procedures. Reasons include delayed gastric emptying, slow small bowel transit, faulty equipment and poor bowel preparation.
  Some protocols identify the capsule position 30 minutes after ingestion using a ‘real-time’ viewer. If the capsule remains in the stomach, mobilisation is encouraged followed by an intramuscular pro-kinetic injection if this fails. This approach has disadvantages since an intramuscular injection is uncomfortable for patients. Additionally metoclopramide, commonly used for this purpose, has a risk of acute dystonic reactions particularly in young patients.
  Recently a handheld magnet (Intromedic Ltd.) has been developed to enable control of the capsule in the upper GI tract. We propose that this could be used, alongside positional changes, to expedite capsule transit through the stomach thus improving completion rates and avoiding the risks of unnecessary medication.
  We wish to undertake a randomised controlled study comparing a standard protocol for small bowel capsule endoscopy against a hand held magnet and positional change protocol to enhance gastric emptying of the wireless capsule.
  Patients attending for small bowel capsule endoscopy will be invited to participate. Trial participants will be randomised to either a standard protocol or the study protocol. The capsule video will be reported by a blinded individual in a standard fashion including a note of the first duodenal image time plus total examination time. Comparison between the two groups and examination completion rates will then be made. The hand held magnet is small and relatively easy to use and therefore if its use i

• REC name

  Yorkshire & The Humber - South Yorkshire Research Ethics Committee

• REC reference

  13/YH/0358

• Date of REC Opinion

  3 Dec 2013

• REC opinion

  Further Information Favourable Opinion