Video Capsule Endoscopy: A Tool for the Assessment of Small Bowel Transit Time

Abstract

PurposeVideo capsule endoscopy (VCE) is a procedure that uses a wireless camera to take pictures of the gastrointestinal (GI) tract. A wireless motility capsule (WMC) of a similar size has been developed, which measures pH, pressure, and temperature and can be used to assess regional and total GI transit times. VCE could also potentially be used as a tool for measuring small bowel transit time (SBTT).MethodsThis study was designed to obtain SBTT from VCE and compare it with historical data generated by WMC. Gastric transit time (GTT) was also measured. Patients were included if the indication for VCE was either iron deficiency anemia (IDA) or overt obscure GI bleed (OOGIB), and they did not have any known motility disorder. Results from VCE were also compared in diabetic vs. non-diabetic patients.ResultsThere were a total of 147 VCE studies performed, including 42 for OOGIB and 105 for IDA. Median GTT and SBTT were 0.3 and 3.6 h, respectively. The overall median GTT and SBTT were 0.3 and 3.6 h, respectively, in the IDA group compared with 0.3 and 3.4 h in the OOGIB group. When compared with WMC, the GTT and SBTT were significantly faster in both groups (GTT: 3.6 h and SBTT: 4.6 h). The median GTT and SBTT were not significantly different in diabetics vs. non-diabetics [GTT: 17.5 vs. 18.0 min (P = 0.86) and SBTT: 3.9 h (237 min) vs. 3.8 h (230 min), respectively (P = 0.90)].ConclusionSBTT as measured using VCE is not significantly different in OOGIB compared with IDA. Both GTT and SBTT are significantly faster as assessed by VCE, which is initiated in the fasting state, compared with WMC measurement, which is initiated after a standard meal. In summary, VCE could potentially be used for measuring SBTT in the fasting state.

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

“…There was no significant difference observed for gender or BMI, which correlates with pre-vious studies using other investigative techniques [14] and studies involving video capsule endoscopy [15]. By means of comparison, ▶ Table 1 summarizes gastric transit times outlined in other video capsule endoscopy studies [5,7,[9][10][11][12][16][17][18]. Importantly, only one study was completed using healthy controls [12].…”

“…The wireless motility capsule, by comparison, estimates and records intestinal transit times, following a meal, by measuring changes in pH, temperature and pressure [5,6]. In addition, both individual variability (of up to 50 % [2]) and lack of agreement between investigations on transit times prevents definition of a universal reference range [7].…”

“…Few investigations allow both direct imaging of intestinal structures as well as calculation of transit time. Video capsule endoscopy is one such modality that incorporates luminal visualisation, similar to standard endoscopy, as well as providing transit time data for the stomach and small intestine [7,8]. Transit time can be calculated through the identification of anatomical landmarks [7].…”

“…Video capsule endoscopy is one such modality that incorporates luminal visualisation, similar to standard endoscopy, as well as providing transit time data for the stomach and small intestine [7,8]. Transit time can be calculated through the identification of anatomical landmarks [7]. Video capsule endoscopy may, therefore, have a role in evaluating symptoms suggestive of gastrointestinal motility disorders as well as other intestinal pathology.…”

“…A further current limitation of video capsule endoscopy as a means of investigating motility disorders is the lack of normal values and clinical significance of transit times which hitherto has been unclear. To date, many of the trials of video capsule endoscopy have involved patients with varying medical conditions such as unexplained iron deficiency anaemia [7], occult gastrointestinal blood loss [9,10], celiac disease [11], functional bowel disorders [12], and critically ill patients [13]. This study aimed to assess gastric and small bowel transit times for healthy ambulatory male and female subjects to establish norms that can inform future diagnostic value of video capsule endoscopy.…”