| Background Capsule endoscopy is the first-line examination for disease of the small bowel.Its battery can work about 8 hours.Most capsule endoscopes can achieve complete small bowel examination during battery operating time.But 10%to 30%of capsule endoscopes cannot achieve that during operating time due to factors other than small bowel neoplasia.Incomplete small bowel examination may miss lesions of distal small bowel.Reasonable improvement gastrointestinal transit time and intestinal mucosal image quality is of great clinical significance for improving the efficiency of capsule endoscopy.Previous studies have shown that gastrointestinal transit time of capsule endoscopy may be affected by a variety of factors,such as prokinetics,body position,chewing gum,and real-time monitoring.A non-randomized controlled study showed that interventions under real-time monitoring such as early drinking water,intravenous metoclopramide,and gastroscopy assisted pushing capsule endoscopy improved complete examination rate and the detection rate of small bowel lesions.Another study showed that clear liquids could clean intestines.Domestic and foreign guidelines recommend that patients may be allowed to drink clear liquids 2 hours after capsule ingestion.But this recommendation lacks evidence-based medical evidence and causes distress to clinicians and patients.Evidence-based medical evidence is urgently needed for the effects of early drinking water on small bowel capsule endoscopy.Aims The aims of this study were to prospectively investigate the effects of early drinking water on capsule endoscopic gastric transit time(GTT),small bowel transit time(SBTT),complete examination rate,the image quality of small bowel,and the detection rate of small bowel lesions.Methods This study was a randomized controlled trial.Patients screened for inclusion criteria and exclusion criteria were randomized into the drinking water group and control group according to 1:1.Patients in the drinking water group drank 200mL of water immediately,10 minutes and 20 minutes after capsule ingestion,and patients in the control group were allowed to drink water 2 hours after capsule ingestion.Real-time monitoring was used in both groups.If the capsule was still in the stomach after 2 hours,the patient was given metoclopramide 1Omg by intramuscular injection.If the capsule was still in the stomach after 3.5 hours,the capsule endoscopy was pushed to the duodenum with the assistance of gastroscopy.The baseline data,GTT,SBTT,complete examination rates,small bowel image quality score and the rates of small bowel lesions were recorded separately,and the risk factors for incomplete small bowel examination were identified by logistics regression analysis.Results A total of 120 patients were enrolled in this study.After statistical analysis,there was no statistical difference in the baseline data between two groups.There were no significant differences in GTT(median:49.50 vs 41.50 minutes,P=0.515),SBTT(mean ± standard deviation:377.12±158.75 vs 361.17±163.12 minutes,P=0.588)and complete examination rate(93.3%vs 95.0%,P>0.999)between the drinking water group and control group.Analysis of all subjects showed that the image quality of proximal small bowel in the drinking water group was higher than that of control group(mean± standard deviation:3.54±0.47 vs 3.29±0.62,P=0.017).There was no significant difference in the image quality of middle and distal small bowel.The detection rate of small bowel lesions in the drinking water group was higher than that in control group(60.0%vs 45.0%,P=0.100),while the difference was not statistically significant.The risk of incomplete small bowel examination increased in patients with GTT>105 minutes by logistic regression model(OR=5.30,95%CI:1.07-26.22).Conclusion 1.Drinking water doesn’t affect the GTT,SBTT and complete examination rate of capsule endoscopy.2.Drinking water can improve the image quality of proximal small bowel in capsule endoscopy.3.Drinking water may improve the detection rate of small bowel lesions in capsule endoscopy,which needs to be verified by a large sample size randomized controlled study.4.A prolonged gastric transit time is an independent risk factor for incomplete small bowel examination of capsule endoscopy. |
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