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Wireless Motility Capsule Versus Other Diagnostic Technologies for Evaluating Gastroparesis and Constipation: A Comparative Effectiveness Review
Comparative Effectiveness Reviews, No. 110
Investigators: Ellen Stein, MD, Zackary Berger, MD, PhD, Susan Hutfless, PhD, Lisa Shah, MD, MAPP, Lisa M Wilson, ScM, Elisabeth B Haberl, BA, Eric B Bass, MD, MPH, and John O Clarke, MD.
Author Information and AffiliationsStructured Abstract
Objectives:
To systematically review the evidence comparing wireless motility capsule (WMC) with other diagnostic tests used for the evaluation of gastroparesis and slow-transit constipation, in terms of diagnostic accuracy, accuracy of motility assessment, effect on treatment decisions, effect on patient-centered outcomes, harms, and effect on resource utilization.
Data sources:
We searched Medline ® and Embase ® from inception through July 2012. Additionally, we scanned reference lists of relevant articles and queried experts.
Review methods:
We included studies in any language that compared WMC with other diagnostic tests among patients with suspected gastroparesis or slow-transit constipation. Two reviewers independently assessed articles for eligibility, serially abstracted data from relevant articles, independently evaluated study quality, and graded the strength of the evidence (SOE). We summarized results qualitatively rather than quantitatively because of the heterogeneity of studies.
Results:
We included 12 studies (18 publications). Seven studies evaluated diagnosis of gastric emptying delay; we found low SOE that WMC alone was comparable to scintigraphy for diagnostic accuracy, accuracy of motility assessment, effect on treatment decisions, and effect on resource utilization. Sensitivity of WMC compared with gastric scintigraphy ranged from 59 to 86 percent and specificity ranged from 64 to 81 percent. We found two studies evaluating WMC as an add-on to other testing. The SOE was low for diagnostic accuracy and for the accuracy of motility assessment by WMC in combination with other modalities. The addition of WMC increased diagnostic yield. Nine studies analyzed colon transit disorders and provided moderate SOE for diagnostic accuracy, accuracy of motility assessment, and harms. WMC was comparable to radiopaque markers (ROM), with concordance ranging between 64 percent and 87 percent. Few harms were reported. The evidence was insufficient to justify conclusions about effects of WMC on treatment decisions and resource utilization.
Conclusions:
WMC is comparable in accuracy to current modalities in use for detection of slow-transit constipation and gastric emptying delay, and is therefore another viable diagnostic modality. Little data are available to determine the optimal timing of WMC for diagnostic algorithms.
Contents
- Preface
- Acknowledgments
- Key Informants
- Technical Expert Panel
- Peer Reviewers
- Associate Editor
- Executive Summary
- Introduction
- Methods
- Results
- Search Results
- Study Design Characteristics
- Study Population Characteristics
- Characteristics of Diagnostic Tests
- KQ 1 Evaluation of Gastric Dysmotility: WMC Alone Versus Other Diagnostic Tests
- KQ 2 Evaluation of Gastric Dysmotility: WMC in Combination With Other Diagnostic Tests Versus Other Diagnostic Tests Alone
- KQ 3 Evaluation of Colonic Dysmotility: WMC Alone Versus Other Diagnostic Tests
- KQ 4 Evaluation of Colonic Dysmotility: WMC in Combination With Other Diagnostic Tests Versus Other Diagnostic Tests Alone
- Study Quality (For All KQs)
- Discussion
- References
- Abbreviations
- Appendix A Detailed Electronic Database Search Strategies
- Appendix B Forms
- Appendix C List of Excluded Articles
- Appendix D Evidence Tables
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10061-I. Prepared by: Johns Hopkins University Evidence-based Practice Center, Baltimore, MD
Suggested citation:
Stein E, Berger Z, Hutfless S, Shah L, Wilson LM, Haberl E, Bass EB, Clarke JO. Wireless Motility Capsule Versus Other Diagnostic Technologies for Evaluating Gastroparesis and Constipation: A Comparative Effectiveness Review. Comparative Effectiveness Review No. 110. (Prepared by Johns Hopkins Evidence-based Practice Center under Contract No. 290 2007 10061-I.) AHRQ Publication No. 13-EHC060-EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm
This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10061-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
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540 Gaither Road, Rockville, MD 20850; www
.ahrq.gov
- Review Wireless Motility Capsule Versus Other Diagnostic Technologies for Evaluating Gastroparesis and Constipation: Future Research Needs: Identification of Future Research Needs From Comparative Effectiveness Review No. 110[ 2013]Review Wireless Motility Capsule Versus Other Diagnostic Technologies for Evaluating Gastroparesis and Constipation: Future Research Needs: Identification of Future Research Needs From Comparative Effectiveness Review No. 110Stein E, Clarke JO, Hutfless S, Boult C, Doggett D, Fawole OA, Bass EB. 2013 May
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