P0675 - Reducing Gastrointestinal Transit Time To Improve Capsule Endoscopy Efficacy: A Systematic Review and Meta-Analysis

Mohammad Jawwad, MBBS¹, Muhammad YN. Chaudhary, MBChB², Muhammad Ismail, MD³, Muhammad H N. Chaudhary, MBChB⁴, Asif Hussain, MBBS⁵, Saifullah Syed, MBBCh⁶, Harmain Muhammad. Asif, MBBS⁷, Monazza Riaz, MBBS⁸, Aqsa Kabir, MBBS¹, Shahzadi Kanwal, MBBS⁹, Umna Naveed, MBChB, MBA, MPH¹⁰, Ali M. Alfalki, MPH¹¹, Oluwagbenga Serrano, MD, FACG¹², Mohammed Barawi, MD^13
1Dow Medical College, Karachi, Sindh, Pakistan; ²Indiana University Southwest, Evansville, IN; ³Indiana University Southwest, Cedar Rapids, IA; ⁴Manchester University NHS Foundation Trust, Stockport, England, United Kingdom; ⁵Liaquat University of Medical and Health Science, Hyderabad, Sindh, Pakistan; ⁶Royal College of Surgeons, Dublin, Dublin, Ireland; ⁷Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Sindh, Pakistan; ⁸Dow Medical College, Norwich, England, United Kingdom; ⁹Karachi Medical and dental college, Karachi, Sindh, Pakistan; ¹⁰NHS, Liverpool, England, United Kingdom; ¹¹University of South Carolina, Columbia, SC; ¹²Good Samaritan Hospital, Vincennes, IN; ¹³Ascension St. John Hospital, Detroit, MI

Introduction: Capsule endoscopy (CE) is a widely used noninvasive technique for visualizing the small bowel (SB) mucosa, but its efficacy is often limited by short battery life. The optimal method for comprehensive SB imaging is debated. Strategies such as purgatives, prokinetics, and magnetic control (MC) aim to reduce gastric and SB transit times, enhancing CE's diagnostic capabilities. This systematic review and meta-analysis compare these methods, evaluating their effectiveness in decreasing transit times and improving completion rates (CRs) of CE.

Methods: A comprehensive literature search was conducted using PubMed, Web of Science, and Scopus, focusing on studies involving purgatives, prokinetics, and MC systems in CE. All studies used the PilliCam SB wireless video capsule (Given® Diagnostic Imaging System). Primary outcomes were gastric transit time (GTT), SB transit time (SBTT), and CR. A random-effects model analyzed direct comparisons between intervention and control groups. Heterogeneity was assessed using the I² statistic. Mean differences (MD) in transit times were reported in minutes, and CRs were presented as odds ratios (ORs) compared to placebo, with 95% confidence intervals.

Results: The meta-analysis included 23 studies comprising 6,779 participants. The magnetic steering group (MSG) had higher odds of completing the SB examination compared to the control group (OR = 1.29 [0.25, 6.54]). The MSG showed a shorter GTT (MD = -14.23 [-71.55, 43.10] min) but a longer SBTT (MD = 12.07 [-17.38, 41.53] min). The lubiprostone group had a longer GTT (MD = 20.80 [-9.87, 51.46] min) and a shorter SBTT (MD = -23.55 [-64.21, 17.11] min) compared to the control group. The metoclopramide group had the highest odds of completing the CE (OR = 2.42 [1.55, 3.77]).Chewing gum and erythromycin showed an increase in SBTT, while the polyethylene glycol group featured a decrease in SBTT. Simethicone did not significantly alter either transit time.(Table 1)

Discussion: The results show erythromycin and MC effectively reduce GTT, while metoclopramide, lubiprostone, and polyethylene glycol decrease SBTT. Metoclopramide and erythromycin also had higher CRs, making them potential preferred agents for improving CE outcomes. These findings support tailored therapeutic approaches to enhance CE efficiency and diagnostic yield, offering valuable guidance for clinicians in selecting appropriate interventions. Maximizing CRs and ensuring proper SB visualization are crucial for successful CE, optimizing clinical practice



Disclosures:


Mohammad Jawwad, MBBS¹, Muhammad YN. Chaudhary, MBChB², Muhammad Ismail, MD³, Muhammad H N. Chaudhary, MBChB⁴, Asif Hussain, MBBS⁵, Saifullah Syed, MBBCh⁶, Harmain Muhammad. Asif, MBBS⁷, Monazza Riaz, MBBS⁸, Aqsa Kabir, MBBS¹, Shahzadi Kanwal, MBBS⁹, Umna Naveed, MBChB, MBA, MPH¹⁰, Ali M. Alfalki, MPH¹¹, Oluwagbenga Serrano, MD, FACG¹², Mohammed Barawi, MD¹³. P0675 - Reducing Gastrointestinal Transit Time To Improve Capsule Endoscopy Efficacy: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.