Cotter José, de Castro Francisca Dias, Magalhães Joana, Moreira Maria João, Rosa Bruno
José Cotter, Francisca Dias de Castro, Joana Magalhães, Maria João Moreira, Bruno Rosa, Gastroenterology Department, Centro Hospitalar do Alto Ave, 4835-044 Guimarães, Portugal.
World J Gastrointest Endosc. 2013 Dec 16;5(12):595-9. doi: 10.4253/wjge.v5.i12.595.
To evaluate whether the use of real time viewer (RTV) and administration of domperidone to patients with delayed gastric passage of the capsule could reduce the rate of incomplete examinations (IE) and improve the diagnostic yield of small bowel capsule endoscopy (SBCE).
Prospective single center interventional study, from June 2012 to February 2013. Capsule location was systematically checked one hour after ingestion using RTV. If it remained in the stomach, the patient received 10 mg domperidone per os and the location of the capsule was rechecked after 30 min. If the capsule remained in the stomach a second dose of 10 mg of domperidone was administered orally. After another 30 min the position was rechecked and if the capsule remained in the stomach, it was passed into the duodenum by upper gastrointestinal (GI) endoscopy. The rate of IE and diagnostic yield of SBCE were compared with those of examinations performed before the use of RTV or domperidone in our Department (control group, January 2009 - May 2012).
Both groups were similar regarding age, sex, indication, inpatient status and surgical history. The control group included 307 patients, with 48 (15.6%) IE. The RTV group included 82 patients, with 3 (3.7%) IE, P = 0.003. In the control group, average gastric time was significantly longer in patients with IE than in patients with complete examination of the small bowel (77 min vs 26 min, P = 0.003). In the RTV group, the capsule remained in the stomach one hour after ingestion in 14/82 patients (17.0%) vs 48/307 (15.6%) in the control group, P = 0.736. Domperidone did not significantly affect small bowel transit time (260 min vs 297 min, P = 0.229). The capsule detected positive findings in 39% of patients in the control group and 49% in the RTV group (P = 0.081).
The use of RTV and selective administration of domperidone to patients with delayed gastric passage of the capsule significantly reduces incomplete examinations, with no effect on small bowel transit time or diagnostic yield.
评估使用实时观察器（RTV）以及对胶囊胃通过延迟的患者给予多潘立酮是否能降低不完全检查（IE）率，并提高小肠胶囊内镜检查（SBCE）的诊断率。
前瞻性单中心干预性研究，时间为2012年6月至2013年2月。在摄入胶囊1小时后使用RTV系统检查胶囊位置。如果胶囊仍留在胃内，患者口服10毫克多潘立酮，30分钟后重新检查胶囊位置。如果胶囊仍留在胃内，则口服第二剂10毫克多潘立酮。再过30分钟后再次检查位置，如果胶囊仍留在胃内，则通过上消化道（GI）内镜将其送入十二指肠。将IE率和SBCE的诊断率与我们科室在使用RTV或多潘立酮之前进行的检查（对照组，2009年1月至2012年5月）进行比较。
两组在年龄、性别、适应症、住院状态和手术史方面相似。对照组包括307例患者，其中48例（15.6%）为IE。RTV组包括82例患者，其中3例（3.7%）为IE，P = 0.003。在对照组中，IE患者的平均胃内时间显著长于小肠检查完整的患者（77分钟对26分钟，P = 0.003）。在RTV组中，14/82例患者（17.0%）在摄入胶囊1小时后胶囊仍留在胃内，而对照组为48/307例（15.6%），P = 0.736。多潘立酮对小肠通过时间没有显著影响（260分钟对297分钟，P = 0.229）。对照组中39%的患者胶囊检测到阳性结果，RTV组为49%（P = 0.081）。
使用RTV以及对胶囊胃通过延迟的患者选择性给予多潘立酮可显著降低不完全检查率，对小肠通过时间或诊断率无影响。
