The Effect of Metoclopramide in Capsule Enteroscopy

Abstract

Clinical utility of prokinetics in capsule endoscopy (CE) is not clearly established. The objective of this prospective, randomized, single-blind, controlled trial was to determine if metoclopramide is useful in CE by increasing the rate of complete enteroscopy. Ninety-five patients referred for CE were randomized to no metoclopramide (group B, n = 48) or 10 mg metoclopramide (group A, n = 47). Complete enteroscopy was possible in 38 patients of group A (80.9%) and 37 of group B (77.1%) (P = 0.422) with two cases of gastric retention in group B (4.2%; P = 0.253). Median gastric transit time was 26 min (1-211) in group A and 28 min (4-200) in group B (P = 0.511). Mean small bowel transit time, calculated after excluding 20 patients with incomplete enteroscopy, was similar in both groups (221.2 ± 89 min vs. 256 ± 82.2 min; P = 0.083). There were also no differences in the total number of findings (group A 4.5 ± 4.7; group B 4.7 ± 3.7, P = 0,815). Administration of 10 mg metoclopramide orally 15 min before capsule ingestion did not significantly increase the rate of total enteroscopies and had no effect on transit times. It also did not modify CE diagnostic yield.

Finding the solution for incomplete small bowel capsule endoscopy

“…In theory, prokinetics might be useful by improving gastric emptying, but their routine use in patients submitted to SBCE is not widely established [17] . Randomized prospective studies failed to demonstrate an improvement in SBCE completion rates with the use of metoclopramide, administered before the procedure [18,19] . One of the recent advances in the field of SBCE is the availability of a portable external viewer for direct monitoring of the images received during the procedure.…”

Endoscopic deployment of video capsule endoscopy: does it guarantee a complete examination of the small bowel?

“…Use of prokinetic agents as a way to reduce gastric transit time and increase the likelihood of a complete small-bowel examination has been met with conflicting results. [11][12][13][14][15][16] Endoscopic placement of the capsule has been used to improve the rate of complete small-bowel examinations. Indications for endoscopic delivery of the capsule were described previously in a small case series, 17 but there is limited information on the success of this technique in allowing a complete examination of the small intestine.…”

Effectiveness of Daikenchuto, a Traditional Japanese Herbal Medicine, in Accelerating Capsule Endoscopy Transit Time- A Prospective Pilot Study

“…Metoclopramide use did not contribute to a significantly shortened time during when the CE remained in the small intestine that led to successful completion of the exam (data not shown). Previous studies did not provide any evidence that metoclopramide use contributed to a more successful CE or a shortened time during when the CEs remained in the lower half of the small intestines [8].…”

“…In order to improve the CE successful complete rate, some GI prokinetic agents such as metoclopramide [8][9], mosapride [10], erythromycin [11][12], and chewing gum [13] have been used to prepare patients. Our study is the first of its kind to report the relationship between DKT use as a prokinetic agent and a reduced time that the capsules remained in the small intestine, as well as a better CE successful completion rate.…”