Introduction Small-bowel capsule endoscopy (SBCE) is often limited by incomplete small-bowel transit. Although there are available meta-analysis data on the use of purgatives in SBCE, there is no similar data or consensus regarding the regular use of prokinetics for capsule ingestion. Our aim was to systematically review existing literature on the use of prokinetics in SBCE.
Methods Thorough and extensive, recursive search of PubMed/MEDLINE, Embase and Scopus databases for studies, published to the end of Nov 2012, was performed. No language, time or age limits were used. Abroad search strategy was employed, using the MeSH term “capsule endoscopy” connected with the following keywords by “AND”: “prokinetic”, “promotility”, “metoclopramide”, “domperidone”, “erythromycin”, “antiemetic”, “ondensetron”, “completion”, “gastric emptying”, “transit”, “ingestion”, “preparation”, “oral/liquid”, “intramuscular” & “retention”. Additionally, the reference list of all the selected articles was manually checked for potentially suitable references that were not identified by the initial search. Studies were selected based on title and/or abstract. Eligible studies were included if the met all of the following criteria: (1)published as full articles of randomised control trials, (2)contained information on the type of the SBCE system used, (3)used prokinetics in (at least) one of the reported study arms/groups, (4)specified the type and dose of prokinetics used & (5)contained data on the rate of SBCE completion to caecum (CR). Data were extracted by the first author using a predifined Excel sheet. Primary end-point: the effect of prokinetics to SBCE CR.
Results A total of 13 studies (all prospective, randomised-controlled, single-centre; total of 1439 subjects) was selected for final review and analysis. In 11 of them, PillCam® (Given®Imaging Ltd) was used; 2 studies were performed with OMOM® (Chongqingjinshan Science & Tech Co, Ltd). 6 studies were designed to look at the value of metoclopramide vs control. In the remainder, other type of prokinetic factors (Erythromycin, Mosapride, Lubiprostone, Deikenchuto or chewing gum) was administered. Using random effects model analysis, the use of prokinetics seem to improve CR in SBCE (OR = 1.888, 95% C.I. = 1.178, 3.02; I2 = 52.5%, P = 0.014). Moreover, in the sub-analysis for metoclopramide studies using fixed effect model, the results were similar (OR = 1.711 95% C.I. = 1.138, 2.573; I2 = 42.3%, P = 0.123).
Conclusion Pooled data show that in comparison to no prokinetic, any type of administered prokinetic factor, before SBCE, improves the SBCE completion rate. Furthermore, most data to present are behind the use of Metoclopramide.
Disclosure of Interest None Declared
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