Failure of capsule transportation due to gastroparesis after gastric truncal vagotomy

Optimal preparation for small bowel examinations with video capsule endoscopy

BACKGROUND

Video capsule endoscopy is a major advance for small bowel exploration. Although the clinical benefit is well accepted, there are still unresolved issues concerning patient preparation.

AIM

This study was set up in order to clarify the clinical benefit of small bowel preparation and give advices in order to obtain the best results for this expensive device.

METHOD

116 patients were randomised in 3 centres between two preparations from the traditional liquid diet versus polyethylene glycol colonoscopy-like preparation. External viewer monitoring and recording pictures were focused on image quality, bubbles or diet residues. Picture qualities were assessed blindly.

RESULTS

For jejunal exploration no differences were noticed between the two preparations but for the ileum, polyethylene glycol preparation gives significant better results than liquid diet: air bubbles (64.4% versus 29.8% p<0.05); opaque residue (83.1% versus 38.6% p<0.05). External viewer was useful in order to use prokinetic drugs in case of delayed gastric emptying.

CONCLUSION

The result leads to a new advice for colleagues in handling patients in order to improve the diagnosis yield by using a modified polyethylene glycol preparation.

Endoscopic pyloric injection of botulinum toxin-A for the treatment of postvagotomy gastroparesis

OBJECTIVES

To evaluate the efficacy of botulinum toxin-A in the treatment of postvagotomy gastroparesis.

METHODS

This open-labeled trial identified and recruited 11 subjects who developed symptomatic gastroparesis after a vagotomy (9 fundoplication, 1 trauma, and 1 exploratory laparotomy). Gastroparesis was defined as an abnormal solid-phase gastric emptying test using the standardized 4-hour radionuclide eggbeater meal method and vagotomy was confirmed with a sham meal challenge test. To complete the study, subjects should have completed the 6-month follow-up visit after their pylorus was injected with botulinum toxin-A injection in a 4-quadrant manner. Patients either received 100 (n = 2) or 200 (n = 9) units of botulinum toxin. Questionnaires recorded symptom severity of gastroparesis at baseline and at monthly intervals for 6 months after the therapy was completed by the patients.

RESULTS

Of the 11 subjects initially recruited, 10 finished the 6-month follow-up visit (7 women). Mean age was 51 years (range, 31-84 years). Mean symptom score at baseline was 16 (95% CI 13-19) and showed a numerical decline to 9 (P > 0.05) over the 6-month period after the procedure (95% CI 5-13). Seven (70%) patients observed >30% improvement in the total symptom score. No complications were recorded.

CONCLUSIONS

In conclusion, this open-label study in patients with postvagotomy gastroparesis patients reveals a reduction of gastroparetic symptoms at 1 and 3 months after treatment with pyloric injection of botulinum toxin-A, with return of symptoms by 6 months. Thus, botulinum toxin treatment does not produce a sustained reduction in gastroparetic symptoms in this clinical setting.