Wireless Capsules Top Scintigraphy for Evaluating Gastroparesis Symptoms
Key findings
- In a novel prospective study, 167 patients with suspected gastroparesis were tested with gastric emptying scintigraphy (GES) and wireless motility capsules (WMCs) concurrently
- Physicians devised three management plans for each patient by considering the results of the two tests separately and together
- Medication changes were recommended more frequently on the basis of WMC results than with GES, and ordering of additional diagnostic tests was less frequent with WMCs than with GES
- Specific choices included more recommendations for prokinetics and laxatives with WMCs and increased ordering of multiple motility tests with GES
- WMCs are better able than GES to detect gastric abnormalities in patients with gastroparesis symptoms and have greater impact on decision-making
Two main types of gastric emptying tests are performed to diagnose gastroparesis. Gastric emptying scintigraphy (GES) measures retention of an isotope-labeled meal, whereas wireless motility capsules (WMCs) detect pH increases as the capsule passes into the duodenum and assess extragastric transit.
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Only one prospective study, limited to GES, has investigated how gastric emptying testing influences subsequent management decisions. To address this knowledge gap, Braden Kuo, MD, gastroenterologist in the Division of Gastroenterology at Massachusetts General Hospital, William L. Hasler, MD, at the University of Michigan Health System, and colleagues recently evaluated patients with gastroparesis symptoms who simultaneously underwent both GES and WMC testing.
In Clinical and Translational Gastroenterology, the team reports that WMCs resulted in more medication changes but less additional diagnostic testing compared with GES because of greater detection of delayed gastric emptying and better profiling of the entire gastrointestinal tract.
Study Methods
This prospective study enrolled 167 patients at 10 centers. Enrolled patients were 18–80 years old, had at least two symptoms suggestive of gastroparesis for at least 12 weeks and had organic disorders excluded from 2013 to 2016.
Based on the results of concurrent GES and WMC testing, an investigator created three management plans for each patient. The first was based on one test (GES or WMC), in alternating order with blinding to the results of the other test. The second was based on the other test (unblinded to the results of the first test). The third was based on the combined GES and WMC results. Management plans were completed for 150 patients.
Outcomes
Based on their findings, the research team made the following decisions:
Medication and Diet Changes
Medication and diet changes were recommended for 74% and 25% of patients, respectively, based on combined GES and WMC results.
WMCs led to more changes in medication than GES did (68% of patients vs. 48%, P < .0001). More medication changes were recommended when only the WMC result was abnormal than when only GES was abnormal (26% vs. 6%, P < .0001). Recommendations for diet changes did not differ according to the type of test.
Orders for Additional Tests
Additional tests were recommended for 81% of patients based on combined GES and WMC results.
Fewer tests were ordered based on WMCs than on GES (P = .0002). More tests were eliminated based on WMCs than on GES (P < .0001). Fewer tests were ordered (P = .0002) and more were eliminated (P < .0001) when only WMC was abnormal than when only GES was abnormal.
Specific Decisions
Changes in prokinetics (P = .0007) and laxatives (P < .0001) were recommended more often based on WMCs than on GES. Recommendations for endoscopy/imaging or additional motility testing were similar with GES and WMCs. Multiple motility tests (≥2 tests for the same participant) were recommended more often based on GES than on WMCs (P < .0001). Additional specific management decisions were made in relation to delayed gastric emptying, delayed extragastric transit or rapid transit.
WMCs are better able than GES to detect gastric abnormalities in patients with gastroparesis symptoms and are better able to profile the entire gastrointestinal tract. The results of this study should be widely generalizable because the decision-making reflected the diverse management approaches of physicians in varied medical settings.
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