The effect of erythromycin on video capsule endoscopy intestinal-transit time

Background: Video capsule endoscopy (VCE) will fail to reach the cecum in 20% of patients within the 8-hour battery life. The use of prokinetics to improve VCE completion rates to the cecum remains unclear. The objective of this study was to determine whether erythromycin increases the completion rate of VCE to the cecum without adversely affecting image quality. Methods: This was a prospective, randomized, single-blinded control trial at St. Vincent's Hospital, Melbourne, Australia. A total of 86 consecutive patients referred for VCE were considered for entry; 45 patients met the entry criteria. These 45 patients were prospectively randomized to no erythromycin (controls, n = 23) or 250 mg erythromycin (n = 22). Two gastroenterologists, who were unaware of which group the patients were randomized into, reported all VCEs. The number of VCEs that reached the cecum within the 8-hour study period, gastric emptying time (GET), and small-bowel transit time (SBTT) were calculated for each group. Results: There was no significant difference in the number of VCEs that reached the cecum (32% failed to reach the cecum in the erythromycin group compared with 22% in the control group), GET, or SBTT between the two groups. Image quality was not adversely affected by the use of erythromycin. The dose and the preparation of erythromycin used in this study may have possibly had an effect on GET and SBTT. Conclusions: The use of erythromycin did not significantly increase the likelihood of the capsule reaching the cecum or affect the degree of visible peristalsis or the interpretation of capsule findings.