Capsule endoscopy: Improving transit time and image view

AIM： To evaluate the effect of various methods of small bowel preparation on the transit time and the quality of visualization of the entire small bowel mucosa. METHODS： Ninety-five patients underwent capsule endoscopy （CE） by easily swallowing the capsule. They were divided into three study groups according to the preparation used： group A （n = 26） by polyethylene glycol （PEG） liter or with sodium phosphate （SP） 12 h prior to the CE study; group B （n = 29） by erythromycin 1 h prior to the CE study; and group C （n = 40） without any preparation. Visualization ranged from good to satisfactory to poor. RESULTS： The gastric emptying time in the group prepared with erythromycin was shorter but without statistical significance and the small bowel transit time was unaffected. In elderly subjects prepared by PEG or SP, the gastric emptying time was significantly longer （163.7 rain, P = 0.05）. The transit times of the three sub-groups were not affected by gender or pathology. The grade of cleaning of the entire study group was 3.27±1.1. The erythromycin group presented significantly the worst quality of images （P = 0.05） compared to the other sub-groups. Age, gender, and pathology had no effect on the quality of the cleaning of the small bowel in the sub-groups. One （1.05%） case had no natural excretion. CONCLUSION： Erythromycin markedly reduces gastric emptying time, but has a negative effect on the quality of the image in the small bowel. The preparation of elderly subjects with PEG or SP has a negative effect on the small bowel transit time.

Effects on the pouch of different digestive tract reconstruction modes assessed by radionuclide scintigraphy

AIM: To determine the effect of three digestive tract reconstruction procedures on pouch function, after radical surgery undertaken because of gastric cancer, as assessed by radionuclide dynamic imaging. METHODS: As a measure of the reservoir function, with a designed diet containing technetium-99m (99mTc), the emptying time of the gastric substitute was evaluated using a 99mTc-labeled solid test meal. Immediately after the meal, the patient was placed in front of a γ camera in a supine position and the radioactivity was measured over the whole abdomen every minute. A frame image was obtained. The emptying sequences were recorded by the microprocessor and then stored on a computer disk. According to a computer processing system, the half-emptying actual curve and the fitting curve of food containing isotope in the detected region were depicted, and the half-emptying actual curves of the three reconstruction procedures were directly compared. RESULTS: Of the three reconstruction procedures, the half-emptying time of food containing isotope in the Dual Braun type esophagojejunal anastomosis procedure (51.86±6.43 min) was far closer to normal, signif icantly better than that of the proximal gastrectomy orthotopic reconstruction (30.07±15.77 min, P=0.002) and P type esophagojejunal anastomosis (27.88±6.07 min, P=0.001) methods. The half-emptying actual curve and f itting curves for the Dual Braun type esophagojejunal anastomosis were fairly similar while those of the proximal gastrectomy orthotopic reconstruction and P type esophagojejunal anastomosis were obviously separated, which indicated bad food conservation in the reconstructed pouches. CONCLUSION: Dual Braun type esophagojejunal anastomosis is the most useful of the three procedures for improving food accommodation in patients with a pouch and can retard evacuation of solid food from the reconstructed pouch.

Influence of Musa Sapientum L. on Pharmacokinetic of Metformin in Diabetic Gastroparesis

Objective： To investigate the effect of Musa sapientum L. （MS） bark juice in diabetic gastroparesis and its effect on pharrnacokinetic of metformin （MET）. Methods： Diabetes was induced in rats by administering alloxan （120 mg/kg） saline solution and maintained for 8 week. All the 18 Sprague-Dawley rats were divided into three groups （n=6 in each group）： normal control, diabetic control and MS bark juice. Assessment of diabetes was done by glucose oxidase-peroxidase method on the 3rd day of alloxan administration. The effects of MS bark juice （100 mL/kg） on gastric emptying time, intestinal transit time, contractility of fundus and pylorus as well as gastdc acid secretion in chronic diabetic rats were observed after 8 weeks of aUoxan administration. The effect of MS bark juice on the pharmacokinetic of orally administered single dose of MET （350 mg/kg） was evaluated on the 57th day of protocol. Any drugs that may reduce the blood glucose level or influence the fibrinolytic system were not used in this study. Results： The MS bark juice significantly reduced the blood glucose level in the diabetic rats （P〈0.01）. There was significant decrease in the pylorus motility and increase in the gastric emptying time, intestinal transit time, contractility of fundus, gastric acid secretion in the MS bark juice treated group （P〈0.01）. There was significant decrease in the time at which drug at a maximum concentration, haft life of drug and increase in the maximum concentration of drug in the plasma of MET in MS bark juice treated group as compared to diabetic control group （P〈0.01）. Conclusion： MS bark juice effectively manages diabetic gastroparesis and thereby improves the bioavailabilty of MET when administered with MS bark iuice.