Use of an external real-time image viewer coupled with prespecified actions enhanced the complete examinations for capsule endoscopy

Background and Aim: The clinical utility of capsule endoscopy (CE) is often limited by incomplete small‐bowel transit. The aim was to determine whether the use of an external real‐time viewer could reduce delays caused by delayed gastric emptying of the capsule or delayed intestinal transit and also improve the rate of positive findings. Methods: We compared the proportion of completed exams and positive results among a group of patients studied before introduction of real‐time viewer and a group in which capsule transit through the esophagus, stomach, and small bowel was regularly monitored and actions (e.g. administration of water or intravenous metoclopramide) were taken if it was delayed. Results: One hundred procedures in the viewer group and 100 control procedures in the age‐matched controls were analyzed. In the viewer group, additional water intake (22 cases) and/or administration of metoclopramide (26 cases) were required. Endoscopic‐assisted duodenal placement of the capsule was required in three cases. Overall one‐third (n = 33) of cases required viewer‐prompted interventions. The completion rate (86% vs 66%, P = 0.002) and the rate of positive findings (80% vs 67%, P = 0.04) were significantly higher in the viewer group compared to the no viewer group. Conclusions: Checking the progress of the capsule with the external real‐time viewer improved the diagnostic yield and completion rate of CE.