Morpho-functional evaluation of small bowel using wireless motility capsule and video capsule endoscopy in patients with known or suspected Crohn’s disease: pilot study

• Main Authors: Diana Yung, Sarah Douglas, Anthony R. Hobson, Andry Giannakou, John N. Plevris, Anastasios Koulaouzidis
• Format: Article
• Language: English
• Published: Georg Thieme Verlag KG 2016-03-01
• Series: Endoscopy International Open
• Online Access: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-100718
• ISSN: 2364-3722; 2196-9736

Background and study aims: SmartPill® (Given Imaging Corp.,Yoqneam,Israel) is an ingestible, non-imaging capsule that records physiological data including contractions and pH throughout the gastrointestinal tract. There are scarce data looking at SmartPill® assessment of patients with known/suspected small-bowel Crohn’s Disease (CD). This pilot study aims to investigate feasibility and safety of SmartPill® to assess gut motility in this group.  Patients and methods: Over 1 year, patients with known/suspected CD, referred for small-bowel capsule endoscopy (SBCE), were invited to participate and 12 were recruited (7 female, 5 male, mean age 44.2 ± 16.6 years). They underwent hydrogen breath test to exclude small-bowel bacterial overgrowth, patency capsule (Agile®), and provided stool samples for fecal calprotectin (FC). Patients ingested PillCam®SB2 and SmartPill® 4 hours apart. Using unpublished data, 33 healthy controls also were identified for the study. P < 0.05 was considered statistically significant. Results: Of the 12 patients enrolled, 10 underwent complete Smartpill® examination (1 stomach retention, 1 dropout). Pillcam® was complete in 10 (1 dropout, 1 stomach retention). Mean fecal calprotectin was 340 ± 307.71 mcg/g. The study group had longer transit times and lower gut motility index than did the controls. The difference in motility appears to be statistically significant (P < 0.05). Longer transit times for SmartPill® (not statistically significant) may have been due to different specifications between the capsules. Limitations included transient Smartpill® signal loss (5/10 studies). Conclusions: This is the first pilot to attempt combining SBCE and SmartPill® to assess small-bowel CD. Data on motility in CD are scarce. Multimodal information can provide a clearer clinical picture. Despite concerns about capsule retention in CD patients, SmartPill® seems safe for use if a patency capsule is employed beforehand.