Ingestion of Simethicone After Capsule Ingestion and Its Impact on Quality of Video Capsule Endoscopy- a Pilot Study
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 6/28/2018 |
| Start Date: | May 3, 2017 |
| End Date: | June 2019 |
| Contact: | Marilyn Fisher, MD |
| Email: | irboard@mail.amc.edu |
| Phone: | (518) 262-5182 |
Wireless video capsule endoscopy (VCE) is a non-invasive technology that looks into small
intestine and gives images of its lumen as the wireless capsule passes through it. It is used
widely to access this anatomically difficult part of the body that cannot be seen via either
colonoscopy or endoscopy. Currently various studies have been done that give multiple
comparisons between various bowel preparation in terms of quality of the small bowel
visualization. No studies have been done where simethicone (Gas-X) is ingested after capsule
swallowing. We intend to give patients simethicone 1 hour after capsule ingestion for two
consecutive hours and compare results of capsule endoscopy outcomes like small bowel transit
time (SBTT), diagnostic yield (DY), small bowel visualization quality (SBVQ) and completion
rate (CR).
intestine and gives images of its lumen as the wireless capsule passes through it. It is used
widely to access this anatomically difficult part of the body that cannot be seen via either
colonoscopy or endoscopy. Currently various studies have been done that give multiple
comparisons between various bowel preparation in terms of quality of the small bowel
visualization. No studies have been done where simethicone (Gas-X) is ingested after capsule
swallowing. We intend to give patients simethicone 1 hour after capsule ingestion for two
consecutive hours and compare results of capsule endoscopy outcomes like small bowel transit
time (SBTT), diagnostic yield (DY), small bowel visualization quality (SBVQ) and completion
rate (CR).
Currently various studies have been done that give multiple comparisons between various bowel
preparation in terms of small bowel transit time (SBTT), diagnostic yield (DY), small bowel
visualization quality (SBVQ), completion rate (CR). Studies suggest that using Polyethylene
glycol (PEG) prep is significantly better compared to clear liquid and overnight fast in
terms if SBVQ and DY (Rokkas et al 2009). Other studies have shown using simethicone 30
minutes before capsule ingestion increases visibility compared to clear liquid and PEG
preparation but no significant difference in gastrointestinal transit time or examination
completion rate (Wei et al 2008). No studies have been done where simethicone is ingested
after capsule swallowing.
Simethicone helps absorb the air bubble in the lumen which can improve the image quality. It
decreases the surface tension of gas bubbles thereby dissolving them and preventing gas
pockets from forming in GI system. It's often used over the counter for gas relief. Gastric
emptying time is usually less than 5 hours, small bowel transit time is usually less than 6
hours, and colonic transit time is usually less than 59 hours (Rao et al 2009). Giving
simethicone till 2 hours after swallowing capsule can help clear gas bubble before the
capsule migrates into the small bowel.
Albert et al 2004 gave patients 80mg simethicone before swallowing the wireless capsule for
their study. Wei et al 2008 gave 300mg of simethicone 20 minutes before swallowing the
capsule. Chen et al 2011 gave 20ml (40mg/ml) simethicone 30 minutes before capsule ingestion
which amounts to 800 mg total. Current FDA recommendation for adults is 500mg maximum daily
dose. The liquid form comes in concentration of 20mg/0.3ml which constitutes to 7.5 ml for
500mg dose.
preparation in terms of small bowel transit time (SBTT), diagnostic yield (DY), small bowel
visualization quality (SBVQ), completion rate (CR). Studies suggest that using Polyethylene
glycol (PEG) prep is significantly better compared to clear liquid and overnight fast in
terms if SBVQ and DY (Rokkas et al 2009). Other studies have shown using simethicone 30
minutes before capsule ingestion increases visibility compared to clear liquid and PEG
preparation but no significant difference in gastrointestinal transit time or examination
completion rate (Wei et al 2008). No studies have been done where simethicone is ingested
after capsule swallowing.
Simethicone helps absorb the air bubble in the lumen which can improve the image quality. It
decreases the surface tension of gas bubbles thereby dissolving them and preventing gas
pockets from forming in GI system. It's often used over the counter for gas relief. Gastric
emptying time is usually less than 5 hours, small bowel transit time is usually less than 6
hours, and colonic transit time is usually less than 59 hours (Rao et al 2009). Giving
simethicone till 2 hours after swallowing capsule can help clear gas bubble before the
capsule migrates into the small bowel.
Albert et al 2004 gave patients 80mg simethicone before swallowing the wireless capsule for
their study. Wei et al 2008 gave 300mg of simethicone 20 minutes before swallowing the
capsule. Chen et al 2011 gave 20ml (40mg/ml) simethicone 30 minutes before capsule ingestion
which amounts to 800 mg total. Current FDA recommendation for adults is 500mg maximum daily
dose. The liquid form comes in concentration of 20mg/0.3ml which constitutes to 7.5 ml for
500mg dose.
Inclusion Criteria:
- patients aged 18 and older
- patients undergoing capsule endoscopy for standard of care
- patients able to give consent for themselves
Exclusion Criteria:
• prisoners
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