Pro-kinetic medications as aids in imaging the small bowel by video-capsule.
The m2a wireless video-capsule (Given Imaging Ltd., Israel) is a miniature ingestible camera utilized for the color imaging of the small intestine walls. Despite its diagnostic yield superiority over all other diagnostic modalities, a substantial part of the pathologies are not spotted. Considering the transmitted pictures high quality a resolution problem is ruled out, but rather it is assumed that parts of the intestinal wall surface are missed in the imaging process. Another important problem is the difficulty encountered by the capsule in crossing the antro-duodenal junction, probably due to pyloric hypomotility. Pro-kinetic drugs are capable of increasing the small intestine peristaltic wave velocity and contractile amplitude, thus assisting the video-capsule movements and widening the camera photo arc. The arc width is directly proportional to the surface imaging capacity. A specific dose range (cisapride 25-30 mg, metoclopramide 30 mg approximately) is calculated and an analysis is made of the use of these pro-kinetic drugs to increase the device diagnostic yield. It should be emphasized that: (1) despite a potential risk for complications, such as bleeding from small intestine lesions, radiological studies underline the high safety profile of metoclopramide; (2) increased capsule speed of progress is not expected to cause a loss of imaged area; (3) an oral dose below 15 mg (metoclopramide or cisapride) may not suffice to accelerate the capsule transit through the antro-duodenal junction. The concept is patent protected.
Schwarzberg
Moshe N
MN
Clalit Health Organization, Horovitz Clinic, Hadar-Yosef, Tel-Aviv, Israel. mosheshw@clalit.org.il
D000932:Antiemetics / Q000009:adverse effects / Q000493:pharmacokinetics; D002214:Capsules; D020117:Cisapride / Q000009:adverse effects / Q000493:pharmacokinetics; D003952:Diagnostic Imaging / Q000379:methods*; D064907:Diagnostic Uses of Chemicals; D064420:Drug-Related Side Effects and Adverse Reactions; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000493:pharmacokinetics; D006471:Gastrointestinal Hemorrhage / Q000473:pathology; D005772:Gastrointestinal Transit; D006801:Humans; D007421:Intestine, Small / Q000473:pathology* / Q000503:physiopathology; D008787:Metoclopramide / Q000009:adverse effects / Q000493:pharmacokinetics; D010528:Peristalsis / Q000502:physiology; D004364:Pharmaceutical Preparations; D014741:Video Recording
D000932:Antiemetics; D002214:Capsules; D064907:Diagnostic Uses of Chemicals; D005765:Gastrointestinal Agents; D004364:Pharmaceutical Preparations; D008787:Metoclopramide; D020117:Cisapride