Al Hillan Alsadiq, Curras-Martin Diana, Carson Michael, Gor Shreya, Ezeume Adaeze, Gupta Varsha, Copcaalvarez Albino, Beri Gagan, Bermann Mordechai, Asif Arif
Internal Medicine, Jersey Shore University Medical Center, Neptune, USA.
Gastroenterology, Jersey Shore University Medical Center, Neptune, USA.
Cureus. 2020 Feb 5;12(2):e6894. doi: 10.7759/cureus.6894.
Background Anesthesia guidelines recommend fasting for at least two hours to minimize aspiration risk related to endoscopic procedures, and the American Society for Gastrointestinal Endoscopy (ASGE) states that the final oral preparation liquid can be administered three to eight hours before the procedure. We have observed the cancellation of endoscopy procedures if liquids were consumed within four, six, or eight hours of the start time. Objectively, documenting gastric transit time via a review of pill endoscopy data could address clinician concerns, prevent delays in patient care, and improve the rate at which our clinicians practice within national guidelines. The objective was to utilize capsule endoscopy data from our center to report the relationship between patient factors that could affect gastric transit time (GTT) and small bowel transit time (SBTT) such as chronic kidney disease (CKD), diabetes mellitus (DM), nutritional status, and obesity. Methods This retrospective review obtained data on adult pill endoscopy (PillCam™ SB 3) (Medtronic, Minneapolis MN) studies on in- and outpatients. Past medical history and laboratory data were abstracted from electronic medical records. Mean GTT and SBTT are reported in minutes + standard deviation (SD) and times were compared accounting for conditions that could prolong transit, such as diabetes mellitus or chronic kidney disease (CKD). Results One hundred and sixty-three records reviewed. Four patients were excluded as the pill did not pass out of the stomach. The mean age was 66 years, 57% were female, and 26% were evaluated for gastrointestinal (GI) bleeding. The mean GTT for all patients (n = 159) was 35 + 49 with a median of 19 minutes. There were no statistically significant differences in GTT between the following subgroups: CKD0 (n = 100) 40 + 58 versus CKD5 (n = 11) 35 + 39, albumin > 3.0 (n = 123) 37 + 53 versus albumin < 3.0 (n = 36) 27 + 30, diabetes mellitus (DM) (n = 40) 51 + 71 vs. non-DM (n = 119) 42 + 79, body mass index (BMI) > 30, or aspirin use. The SBTT results in all patients (n = 124) was 238 + 88 minutes. Similarly, there was no relation between SBTT and albumin, any CKD, CKD0 versus CKD5, DM status, or BMI. The patients with the capsule stuck in the stomach did not have any other clinical history to explain this occurrence. Conclusions This analysis of objective data regarding pill endoscopy found that the mean GTT was 44 minutes, and it was < 60 minutes for 85% of the cohort. Patient factors were not associated with longer transit times, and this is the first report to document PillCam times in relation to CKD. These data support recommendations that endoscopic procedures, in accordance with anesthesia and ASGE guidelines, can be safely conducted in the majority of patients within 60 minutes of ingesting liquids.
背景 麻醉指南建议禁食至少两小时，以将与内镜检查相关的误吸风险降至最低，美国胃肠内镜学会（ASGE）指出，最后的口服制剂液体可在检查前3至8小时服用。我们观察到，如果在开始时间的4、6或8小时内饮用了液体，内镜检查程序会被取消。客观地说，通过回顾药丸内镜数据记录胃传输时间可以解决临床医生的担忧，防止患者护理延误，并提高我们的临床医生在国家指南范围内的执业率。目的是利用我们中心的胶囊内镜数据，报告可能影响胃传输时间（GTT）和小肠传输时间（SBTT）的患者因素之间的关系，如慢性肾脏病（CKD）、糖尿病（DM）、营养状况和肥胖。方法 这项回顾性研究获取了关于成人药丸内镜（PillCam™ SB 3）（美敦力公司，明尼阿波利斯，明尼苏达州）对门诊和住院患者研究的数据。既往病史和实验室数据从电子病历中提取。平均GTT和SBTT以分钟+标准差（SD）报告，并对可能延长传输时间的情况（如糖尿病或慢性肾脏病（CKD））进行时间比较。结果 共审查了163份记录。4名患者被排除，因为药丸未排出胃外。平均年龄为66岁，57%为女性，26%因胃肠道（GI）出血接受评估。所有患者（n = 159）的平均GTT为35 + 49分钟（中位数为19分钟）。以下亚组之间的GTT无统计学显著差异：CKD0（n = 100）40 + 58分钟与CKD5（n = 11）35 + 39分钟，白蛋白> 3.0（n = 123）37 + 53分钟与白蛋白< 3.0（n = 36）27 + 30分钟，糖尿病（DM）（n = 40）51 + 71分钟与非DM（n = 119）42 + 79分钟，体重指数（BMI）> 30或使用阿司匹林。所有患者（n = 124）的SBTT结果为238 + 88分钟。同样地，SBTT与白蛋白、任何CKD、CKD0与CKD5、DM状态或BMI之间均无关联。胶囊卡在胃里的患者没有任何其他临床病史来解释这种情况的发生。结论 这项关于药丸内镜的客观数据分析发现，平均GTT为44分钟，85%的队列GTT < 60分钟。患者因素与较长的传输时间无关，这是第一份记录与CKD相关的PillCam时间的报告。这些数据支持根据麻醉和ASGE指南，在大多数患者摄入液体后60分钟内安全进行内镜检查程序的建议。
