Comparison of gastric emptying of a nondigestible capsule to a radio-labelled meal in healthy and gastroparetic subjects

Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.73). 02/2008; 27(2):186-96. DOI: 10.1111/j.1365-2036.2007.03564.x
Source: PubMed


Gastric emptying scintigraphy (GES) using a radio-labelled meal is used to measure gastric emptying. A nondigestible capsule, SmartPill, records luminal pH, temperature, and pressure during gastrointestinal transit providing a measure of gastric emptying time (GET).
To compare gastric emptying time and GES by assessing their correlation, and to compare GET and GES for discriminating healthy subjects from gastroparetics.
Eighty-seven healthy subjects and 61 gastroparetics enrolled with simultaneous SmartPill and GES. Fasted subjects were ingested capsule and [(99m)Tc]-SC radio-labelled meal. Images were obtained every 30 min for 6 h. Gastric emptying time and percentage of meal remaining at 2/4 h were determined for each subject. The sensitivity/specificity and receiver operating characteristic analysis of each measure were determined for each subject.
Correlation between GET and GES-4 h was 0.73 and GES-2 h was 0.63. The diagnostic accuracy from the receiver operating characteristic curve between gastroparetics and healthy subjects was GET = 0.83, GES-4 h = 0.82 and GES-2 h = 0.79. The 300-min cut-off time for GET gives sensitivity of 0.65 and specificity of 0.87 for diagnosis of gastroparesis. The corresponding sensitivity/specificity for 2 and 4 h standard GES measures were 0.34/0.93 and 0.44/0.93, respectively.
SmartPill GET correlates with GES and discriminates between healthy and gastroparetic subjects offering a nonradioactive, standardized, ambulatory alternative to scintigraphy.

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    • "The best correlation was with the GES at 4 hours with a correlation coefficient of 0.73. The capsule detects more delay in GET than GES (65% vs. 44%) presumably because it also measures the fasting state.10 On the other hand, the cut-off for rapid GET with the capsule is unclear since the 2-hour proposed cut-off is not validated against scintigraphy and there is only one study which has shown that WMC was diagnostically useful but the sample size was small.5 "
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    • "Previous studies have shown a good correlation between gastric emptying of a radiolabeled meal and gastric residence time of the capsule [11]. Furthermore, significant differences in gastric emptying time of the capsule were observed between healthy controls and patients with a history of gastroparesis [12]. The wireless motility capsule also was capable of detecting differences in the frequency and motility index of antral and duodenal contractions in patients with severe gastroparesis compared to healthy controls or patients with mild to moderate gastroparesis [13]. "
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