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W1183 Chewing Gum Shortens Small Bowel but Not Gastric Transit Time During Capsule Endoscopy
in GT and SBT between historical controls and those chewing gum during VCE and Chi squared analysis was used to compare proportions. A p-value of ≤ 0.05 was considered significant. Results: Of the 100 controls patients 69 were female whilst 43 of test patients where female. The mean age was 61 years (SD 15) and 63 (SD 15) respectively. GT was not altered by chewing gum (mean 40 minutes vs 36 in controls, p=0.27). SBT was significantly shorter, by a mean 30minutes (217, SD 94 vs 187 SD 84, p=0.02). There was no significant difference between the proportion of complete small bowel examinations between the two groups (Control 12% and test 10% incomplete, p=0.73). There was no difference between the diagnostic yield from each group (p = 0.90). Discussion: Chewing gum during VCE significantly altered SBT but not GT suggesting a differential effect of chewing on gastric and small bowel motility. Importantly the diagnostic yield of VCE was not altered by the more rapid small bowel transit during the procedure. The combination of chewing gum and a prokinetic agent, with its effect on the proximal GIT, may enhance capsule transit even further, warranting consideration of prospective controlled trials. Apostolopoulos P, Kalantzis C, Gralneck IM, et al. Aliment Pharmacol Ther 2008;28:405- 411. W1184 How to Improve Video Capsule Image Visibility? Jean-Francois Rey, Uwe Seitz Background: Video Capsule Endoscopy (VCE) is the gold standard for small bowel diagnosis especially in obscure GI bleedings and suspected Crohn diseases. But, due to technical limitation and absence of inflation, the images are sometimes difficult to assess compared to enteroscopy. Aim: We have investigated the clinical benefit of a new contrast capsule in order to improve image visibility. Method: Contrast capsule is a prototype (EC Type Y0001) developed by Olympus in order to enhance image visibility with a special “blue-enhanced white-light LED”. Aside of usual RGB white-light, this prototype VCE has a contrast image generated out of green and blue to make superficial structures more visible. This selected wavelength has increased illumination intensity in blue-light where is ranged the main absorption of hemoglobin. Results: In 14 patients with obscure GI bleeding or suspected Crohn, we assess diagnosis with white-light, with the usual software functions. Then we switch to a contrast mode on a specific pathological area. For superficial vessels or angiodysplasia, the contrast capsule enhances the microvessels' edges. The most important improvements are in Crohn diseases: disrupted mucosal pattern, inflammatory vessels are much more visible and allow a better mucosal evaluation of damage or healing. This last feature could be particularly useful in monitoring the effect of medical treatment on mucosa's healing. Conclusion: In this early clinical trial, contrast capsule seems to add a clinical benefit in order to assess small bowel superficial abnormality already diagnosed with the white-light VCE.
Values shown are mean ± standard error W1182 Does Small Intestinal Bacterial Overgrowth Affect pH Readings as Recorded by Wireless Motility Capsule Technology in the GI Tract? Irene Sarosiek, Boguslawa Sochacka, Katherine Roeser, Jerzy Sarosiek, Richard McCallum Introduction: Recently, the concept of small bowel transit time (SBTT) and assessing regional gut transit was introduced based on a data obtained by wireless motility capsule (WMC) technology. SBTT is defined as the elapsed time from gastric emptying until the capsule's arrival at the caecum as determined by a sudden drop of pH > 1unit, for longer then 1 h, which was preceded by a gradual, sustained rise in pH as the capsule passes through the distal small bowel. The pH drop indicates SP arrival at the ileocaecal junction (ICJ). The question of whether small intestinal bacterial overgrowth (SIBO) changes pH parameters in the small bowel or affects pH criteria for documenting ceceal arrival is unknown. Aim: To investigate the profile of WMC recordings of pH readings before and after reaching the ICJ in patients with chronic constipation (CC) with and without documented SIBO. Methods: 25 WMC recordings were obtained from CC patients (all female, mean age 40 (21-64) mean weight 171 lbs (114-250). pH was measured every 10 min for 2 h prior to and 1 h after arrival of WMC at the ICJ and the median pH during these times was calculated. Conventional breath tests with Lactulose (LBT) and glucose (GBT)- hydrogen and methane measurementswere performed on all patients immediately preceding WMC recordings. Results: The median value of pH in all patients was 7.06 during 2h and 7.25 during 1h before arrival at the ICJ. The median pH was 5.82 during the 1h after ICJ arrival. 10 WMC recordings were obtained from CC patients with SIBO positive (+) results (both LBT/GBT) and from15 SIBO negative (-) subjects. The median pH in the (+) group was 7.15 during 2h, and 7.30 during 1h prior to reaching the ICJ. It was 5.80 during 1h after arrival at ICJ. While in SIBO (-) CC patients the median pH was 6.90; 7.10 and 5.70 respectively with no significant differences between the 2 groups. Interestingly, there was a correlation observed between max pH value during1 h before and after ICJ in SIBO (-) group of CC patients. Conclusions: 1) There is no statistically significant difference in pH readings in the distal small bowel observed between constipated patients with documented (+) or (-) SIBO by LBT/GBT. 2) WMC technology which relies on pH assessment in the gut is a very effective test in providing accurate readings related to the assessment of SBTT and regional transit times of the GI tract even in the presence of bacterial overgrowth in the small intestine.
W1185 Samll Bowel Injury in Patients Receiving Low-Dose, Long Term Aspirin Treatment: A Case Control Study Lassad Chtourou, Bakhtiar Bejou, Gheorghe Airinei, Cyriaque Bon, Jean-Jacques Raynaud, Thomas Aparicio, Robert Benamouzig Intestinal aspirin's toxicity remains a subject of controversy. A study of healthy volunteers investigated by small bowel Video Capsule Endoscopy (VCE) has recently suggested that a short aspirin treatment with cardiovascular preventive dose (<300 mg/24 h) could be associated with mucosal lesions and bleeding. The objective of this study was to prospectively evaluate by VCE (Pillcam SB, Given Imaging, Yoqneam, Israel) the incidence of lesions of the small intestine in patients investigated for obscure GI bleeding (OGIB), receiving a long term, low-dose Aspirin treatment. Patients and Methods: Twenty-eight patients who underwent a small bowel VCE (Pillcam SB, Given Imaging, Yoqneam, Israel) for OGIB were prospectively studied over a period of 18 months (January 2008 - June 2009). Fourteen patients were long term users of low-dose aspirin (≥ 24 months). For each patient, a control matche for age, sex and hemoglobin was included. All VCE reviews have been evaluated independently by two experts, blind to aspirin treatment. The lesions were initially classified as major lesions (sores, ulcers, fissures and angiodysplasia) and minor injuries (visible blood, red spots, erosions, erythema, edema and mucosal petechiae). The lesions were subsequently quantified. Results: The incidence of major lesions was significantly higher in the group receiving low-dose aspirin (21 vs. 9 ulcerations, ulcers 5 vs. 2; cracks 1 vs 0; angiodysplasias 1 vs 0, p = 0.04). The minor injuries did not differ significantly between the two groups (petechiae 1vs 1; red spots 19 vs 18; visible blood 2 vs. 3; erosions 30 vs 25; erythema 7 vs 5; mucosal edema 0 vs 6, p = 0.39) . The total number of lesions did not differ significantly between the two groups (p = 0.09). The VCE has identified at least one lesion in all patients. Lesions were multifocal in most case. There was no incidence of capsule retention. Conclusion: This study demonstrates for the first time that low-dose; long term Aspirin treatment is associated with a higher prevalence of intestinal lesions in patients who receive VCE for OGIB. The most common lesions are ulcerations and ulcers.
W1183 Chewing Gum Shortens Small Bowel but Not Gastric Transit Time During Capsule Endoscopy Thao T. Lam, Andrew D. Keegan
W1186
Video Capsule endoscopy (VCE) is a powerful tool in the assessment of small bowel pathology. However, one of its limitations is the generally small but potentially significant proportion of cases in which the capsule does not reach the caecum by the end of the recording time. Although several criteria have been suggested to predict small bowel transit and completeness of small bowel examination none are reliable in a clinical setting. Apostolopoulos et al suggested that chewing gum during VCE could shorten small bowel transit times although without a significant reduction in incomplete examinations. The aim of this study was to determine the effect of chewing gum during VCE in patients undergoing VCE for obscure GI blood loss on gastric (GT) and small bowel transit (SBT) times and the proportion of cases with complete small bowel examination. Methods: All VCE examinations were undertaken using the disposable *PillCam* (Given Imaging).Images were analysed using the manufacturer's proprietary software. Patients were asked to chew sugarless gum for 20 to 30 minutes at capsule ingestion, 2 hours and 4 hours. T-test was applied to test for differences
A Portable Wireless System for Integrated Batteryless Impedance- And pHSensor Implants to Detect GERD Episodes Sandeep Battula, Lun-Chen Hsu, Wen-Ding Huang, Shou Jiang Tang, Stuart J. Spechler, Harry F. Tibbals, J. C. Chiao Introduction: In earlier studies, we developed an implantable, batteryless and wireless capsule, which integrated impedance- and pH-sensing electrodes, that could detect both acidic and nonacidic gastroesophageal reflux episodes in animals. In this work, we describe the development of a wearable, wireless module as the reader for the implantable capsule. We also have conducted bench-top tests of the fidelity of the entire system. Methods: A portable reader, which is worn on the chest, was designed to transmit radio-frequency power to and establish wireless communication with the implant by inductive coupling. A power amplifier sent carrier signals to the batteryless implant. A demodulation circuit, integrated
S-669
AGA Abstracts
AGA Abstracts
We graded VCE findings based on the P0-P2 grading system [Saurin Endoscopy 2003;35:576584] where P0 was a normal exam, P1 a finding of questionable relevance, and P2 a findings of significant clinical relevance (including blood in the lumen). We classified findings as normal examination, AVMs, blood in the lumen without a source visualized, ulcerations, strictures, red spots, definite mass, submucosal lesion, abnormal mucosa, and other findings. If more than one lesion was found on the examination, we classified the study using the most significant clinical lesion. We determined location of the finding as proximal or distal small bowel based on small bowel transit time. We did not consider gastritis or duodenitis as significant findings. Results: We enrolled 624 VCE studies, 119 performed on inpatients, and 505 as outpatient exams. Data is shown in the Table. Gastric transit time, gastric capsule retention, and incomplete small bowel studies were more likely to occur in inpatients. Inpatient studies were more likely to reveal significant lesions including AVMs and blood. Conclusions: There were more incomplete studies on inpatients despite a higher rate of endoscopic placement. Despite the incomplete study rate, there was a higher diagnostic yield. Comparison of Inpatient and Outpatient VCE Studies
Values shown are mean ± standard error W1182 Does Small Intestinal Bacterial Overgrowth Affect pH Readings as Recorded by Wireless Motility Capsule Technology in the GI Tract? Irene Sarosiek, Boguslawa Sochacka, Katherine Roeser, Jerzy Sarosiek, Richard McCallum Introduction: Recently, the concept of small bowel transit time (SBTT) and assessing regional gut transit was introduced based on a data obtained by wireless motility capsule (WMC) technology. SBTT is defined as the elapsed time from gastric emptying until the capsule's arrival at the caecum as determined by a sudden drop of pH > 1unit, for longer then 1 h, which was preceded by a gradual, sustained rise in pH as the capsule passes through the distal small bowel. The pH drop indicates SP arrival at the ileocaecal junction (ICJ). The question of whether small intestinal bacterial overgrowth (SIBO) changes pH parameters in the small bowel or affects pH criteria for documenting ceceal arrival is unknown. Aim: To investigate the profile of WMC recordings of pH readings before and after reaching the ICJ in patients with chronic constipation (CC) with and without documented SIBO. Methods: 25 WMC recordings were obtained from CC patients (all female, mean age 40 (21-64) mean weight 171 lbs (114-250). pH was measured every 10 min for 2 h prior to and 1 h after arrival of WMC at the ICJ and the median pH during these times was calculated. Conventional breath tests with Lactulose (LBT) and glucose (GBT)- hydrogen and methane measurementswere performed on all patients immediately preceding WMC recordings. Results: The median value of pH in all patients was 7.06 during 2h and 7.25 during 1h before arrival at the ICJ. The median pH was 5.82 during the 1h after ICJ arrival. 10 WMC recordings were obtained from CC patients with SIBO positive (+) results (both LBT/GBT) and from15 SIBO negative (-) subjects. The median pH in the (+) group was 7.15 during 2h, and 7.30 during 1h prior to reaching the ICJ. It was 5.80 during 1h after arrival at ICJ. While in SIBO (-) CC patients the median pH was 6.90; 7.10 and 5.70 respectively with no significant differences between the 2 groups. Interestingly, there was a correlation observed between max pH value during1 h before and after ICJ in SIBO (-) group of CC patients. Conclusions: 1) There is no statistically significant difference in pH readings in the distal small bowel observed between constipated patients with documented (+) or (-) SIBO by LBT/GBT. 2) WMC technology which relies on pH assessment in the gut is a very effective test in providing accurate readings related to the assessment of SBTT and regional transit times of the GI tract even in the presence of bacterial overgrowth in the small intestine.
W1185 Samll Bowel Injury in Patients Receiving Low-Dose, Long Term Aspirin Treatment: A Case Control Study Lassad Chtourou, Bakhtiar Bejou, Gheorghe Airinei, Cyriaque Bon, Jean-Jacques Raynaud, Thomas Aparicio, Robert Benamouzig Intestinal aspirin's toxicity remains a subject of controversy. A study of healthy volunteers investigated by small bowel Video Capsule Endoscopy (VCE) has recently suggested that a short aspirin treatment with cardiovascular preventive dose (<300 mg/24 h) could be associated with mucosal lesions and bleeding. The objective of this study was to prospectively evaluate by VCE (Pillcam SB, Given Imaging, Yoqneam, Israel) the incidence of lesions of the small intestine in patients investigated for obscure GI bleeding (OGIB), receiving a long term, low-dose Aspirin treatment. Patients and Methods: Twenty-eight patients who underwent a small bowel VCE (Pillcam SB, Given Imaging, Yoqneam, Israel) for OGIB were prospectively studied over a period of 18 months (January 2008 - June 2009). Fourteen patients were long term users of low-dose aspirin (≥ 24 months). For each patient, a control matche for age, sex and hemoglobin was included. All VCE reviews have been evaluated independently by two experts, blind to aspirin treatment. The lesions were initially classified as major lesions (sores, ulcers, fissures and angiodysplasia) and minor injuries (visible blood, red spots, erosions, erythema, edema and mucosal petechiae). The lesions were subsequently quantified. Results: The incidence of major lesions was significantly higher in the group receiving low-dose aspirin (21 vs. 9 ulcerations, ulcers 5 vs. 2; cracks 1 vs 0; angiodysplasias 1 vs 0, p = 0.04). The minor injuries did not differ significantly between the two groups (petechiae 1vs 1; red spots 19 vs 18; visible blood 2 vs. 3; erosions 30 vs 25; erythema 7 vs 5; mucosal edema 0 vs 6, p = 0.39) . The total number of lesions did not differ significantly between the two groups (p = 0.09). The VCE has identified at least one lesion in all patients. Lesions were multifocal in most case. There was no incidence of capsule retention. Conclusion: This study demonstrates for the first time that low-dose; long term Aspirin treatment is associated with a higher prevalence of intestinal lesions in patients who receive VCE for OGIB. The most common lesions are ulcerations and ulcers.
W1183 Chewing Gum Shortens Small Bowel but Not Gastric Transit Time During Capsule Endoscopy Thao T. Lam, Andrew D. Keegan
W1186
Video Capsule endoscopy (VCE) is a powerful tool in the assessment of small bowel pathology. However, one of its limitations is the generally small but potentially significant proportion of cases in which the capsule does not reach the caecum by the end of the recording time. Although several criteria have been suggested to predict small bowel transit and completeness of small bowel examination none are reliable in a clinical setting. Apostolopoulos et al suggested that chewing gum during VCE could shorten small bowel transit times although without a significant reduction in incomplete examinations. The aim of this study was to determine the effect of chewing gum during VCE in patients undergoing VCE for obscure GI blood loss on gastric (GT) and small bowel transit (SBT) times and the proportion of cases with complete small bowel examination. Methods: All VCE examinations were undertaken using the disposable *PillCam* (Given Imaging).Images were analysed using the manufacturer's proprietary software. Patients were asked to chew sugarless gum for 20 to 30 minutes at capsule ingestion, 2 hours and 4 hours. T-test was applied to test for differences
A Portable Wireless System for Integrated Batteryless Impedance- And pHSensor Implants to Detect GERD Episodes Sandeep Battula, Lun-Chen Hsu, Wen-Ding Huang, Shou Jiang Tang, Stuart J. Spechler, Harry F. Tibbals, J. C. Chiao Introduction: In earlier studies, we developed an implantable, batteryless and wireless capsule, which integrated impedance- and pH-sensing electrodes, that could detect both acidic and nonacidic gastroesophageal reflux episodes in animals. In this work, we describe the development of a wearable, wireless module as the reader for the implantable capsule. We also have conducted bench-top tests of the fidelity of the entire system. Methods: A portable reader, which is worn on the chest, was designed to transmit radio-frequency power to and establish wireless communication with the implant by inductive coupling. A power amplifier sent carrier signals to the batteryless implant. A demodulation circuit, integrated
S-669
AGA Abstracts
AGA Abstracts
We graded VCE findings based on the P0-P2 grading system [Saurin Endoscopy 2003;35:576584] where P0 was a normal exam, P1 a finding of questionable relevance, and P2 a findings of significant clinical relevance (including blood in the lumen). We classified findings as normal examination, AVMs, blood in the lumen without a source visualized, ulcerations, strictures, red spots, definite mass, submucosal lesion, abnormal mucosa, and other findings. If more than one lesion was found on the examination, we classified the study using the most significant clinical lesion. We determined location of the finding as proximal or distal small bowel based on small bowel transit time. We did not consider gastritis or duodenitis as significant findings. Results: We enrolled 624 VCE studies, 119 performed on inpatients, and 505 as outpatient exams. Data is shown in the Table. Gastric transit time, gastric capsule retention, and incomplete small bowel studies were more likely to occur in inpatients. Inpatient studies were more likely to reveal significant lesions including AVMs and blood. Conclusions: There were more incomplete studies on inpatients despite a higher rate of endoscopic placement. Despite the incomplete study rate, there was a higher diagnostic yield. Comparison of Inpatient and Outpatient VCE Studies