Evaluating video capsule endoscopy in diabetes mellitus: transit times, preparation adequacy, and the influence of insulin and GLP-1 receptor agonist use.

Abstract

Background: Delayed gastrointestinal transit time (TT), frequently observed in diabetes mellitus (DM), may hinder bowel preparation quality and visualization in video capsule endoscopy (VCE).

Objectives: The study aim was to compare VCE preparation adequacy and completion rates between patients with and without DM.

Design: Retrospective analysis of a prospectively maintained database, including all consecutive VCEs performed in patients aged ⩾35 years.

Methods: Patients were divided into two groups based on a DM diagnosis reported at admission and confirmed by medication records. Clinico-demographic characteristics, bowel preparation quality, TTs, and completion rates were compared between the groups. Logistic regression analysis was performed to identify independent risk factors for inadequate bowel preparation.

Results: Out of 672 included VCEs, 189 (28.1%) patients had DM and 483 (71.9%) were controls. Completion rates were comparable (DM-98.4% vs controls-99.0%, p = 0.553). Gastric TT was similar (DM-37.5 ± 45.5 vs controls-34.3± 48.6 min, p = 0.420), while small bowel TT was longer (DM-261.8 ± 95.6 vs controls-244.9 ± 98.4 min, p = 0.040). DM patients had higher inadequate preparation rates (31.2% vs controls-23.4%, p = 0.040). In a multivariate analysis adjusted for age and gender, DM was not independently associated with inadequate preparation. However, DM treated with insulin (26.5% of patients with DM) was significantly associated with inadequate bowel preparation (Odds ratio (OR) 2.355, p = 0.006). Glucagon-like peptide-1 receptor agonist usage (11.8% of patients with DM patients) compared to no-DM controls achieved borderline significance as a risk factor for preparation inadequacy (OR 2.148, 95% CI 0.887-5.201, p = 0.090).

Conclusion: VCE appears to be feasible in patients with DM, with similar completion rates and gastric TTs despite slightly prolonged small bowel TTs. However, DM treated with insulin is a significant risk factor for inadequate bowel preparation, suggesting the need for a more intensive preparation protocol within this patient group.