TBA (22W120)

Oral peppermint solution as an aid to improve completion rates in capsule endoscopy.

Author(s)

F.O’Hara, A.O'Connor, N.Breslin, B.Ryan, S.O'Donnell, D. McNamara

Department(s)/Institutions

Tallaght University Hospital, Dublin TAGG, Department of Medicine, Trinity College Dublin

Introduction

Delayed gastric transit is a risk factor for incomplete capsule endoscopy (CE). Patients with risk factors for this may benefit from prokinetics. IV Metoclopramide (M) is commonly used but is associated with infrequent but serious adverse effects. Oral peppermint solution (PS) has been reported to aid gastric emptying.

Aims/Background

Aim: To assess the efficacy of peppermint oil as a prokinetic in patients at risk of incomplete SBCE.

Method

We performed an open-label randomised pilot study comparing 90mg of PS versus 10mg M. A matched control group (C) without risk factors was included for comparison. Patients for CE with risk factors for delayed gastric transit were included. Those with delayed transit at 30 minutes post capsule ingestion received either PS or M. If the capsule remained in the stomach 30 minutes later, a second prokinetic was administered.

Results

150 cases were included, PS (n=46, 31%) and M (n=53, 35%) and C (51, 34%). 30 minutes later the capsule had passed to the small bowel in only 30.4%(14/46) of PS group vs 84.9%(45/53) of M group (p<0.001%; 95% CI 38.05%-70.89%). Gastric transit times (GTT) were PS (111min) vs M (97min, p=0.1582) vs C (34min, p<0.001). Small bowel transit time (SBTT) was significantly shorter in PS (118min) vs M (193min, p=0.001) and C (228min, p<0.001). Completion rates were similar; PS (83.3%) vs M (90.2%) vs C (96.3%).

Conclusions

Initially PS seemed to be an ineffective prokinetic. However, PS shows a significantly shortened SBTT compared to M or C indicating a possible delayed prokinetic effect. Recognition of this will help us further assess its utility as a prokinetic in CE.