The use of real time monitoring with prokinetics in small bowel capsule endoscopy patients at risk of delayed gastric emptying not only reduces rates of gastric retention but also of incomplete small bowel transit

Aims Incomplete studies due to gastric retention and incomplete small bowel transit are recognised limitations of small bowel capsule endoscopy. Real time monitoring and prokinetic use in at risk patients is recommended. Its impact on small bowel capsule efficacy in day to day clinical practice is unclear. We aim to determine the rates of gastric retention and incomplete small bowel transit and to examine the effect of real time monitoring with prokinetics.

Methods Data for 6 months was analysed from the voluntary online prospectively maintained Irish national capsule registry. The registry includes data on an individual’s gastric retention risk (hypothyroidism, medications, diabetes, parkinsons, prior retention, prior gastric surgery, known gastroparesis, other), the administration of prokinetics (peppermint oil or metoclopramide or erythromycin or both metoclopramide and erythromycin), gastric retention, and small bowel transit. Gastric retention and incomplete Small bowel transit rates were compared between patients at risk of retention and controls using a Chi square test and controlled for prokinetic use. A p<0.05 was considered significant.

Results Gastric retention risk was recorded in 799/826 (97%) of capsules. 251(31%) had a gastric retention risk and therefore underwent real time monitoring with administration of a prokinetic if the capsule remained in the stomach at 30-60 minutes. 43/235 (18%) of these received a prokinetic. The rate of gastric retention in the at-risk group (10/249, 4%) and controls (24/548, 4%) was similar (p=0.96). Gastric retention rates were not affected by age or gender. Incomplete small bowel transit was similar in both groups; 6% (16/250) in the at-risk group versus 4% (22/548) in controls (p=0.15). In all capsules, prokinetics were given in 63/664 (9%) and use did not affect incomplete small bowel transit, 29/601 (5%) in those that did not receive a prokinetic versus 1/63 (2%) in those that received a prokinetic (p=0.2). However in the gastric retention risk group, prokinetic use significantly reduced the incomplete small bowel transit rate 1/43 (2%) versus 15/192 (8%) (p=0.05).

Conclusions A consistent gastric retention rate of 4% was identified. Real time monitoring with prokinetic use if the capsule remains in the stomach at 30-60 minutes is effective in bringing gastric retention in at-risk patients to the baseline rate seen in capsules without these risks. In our at risk cohort prokinetic use was also associated with higher complete small bowel transit and warrants further investigation.

Publication History

Article published online:
27 March 2025