Impact of insulin resistance, obesity and the metabolic syndrome on time taken to examine the small bowel at capsule endoscopy

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All patients already referred for capsule endoscopy during the study period over the age of 18 years old and are able to provide informed consent are to be invited to participate in the study. Capsule endoscopy is where a camera and wireless transmitter are packaged in a small, pill shaped device. This is swallowed by the patient and images are recorded as the devices passes through the bowel. These images are then interpreted to help diagnose intestinal disorders. This procedure is usually undertaken to investigate anaemia and obscure gastrointestinal bleeding. Incomplete studies can limit the utility of the study and identification of factors that may impact transit will help identify patients at risk of incomplete examination. Those that do consent will have clinical parameters recorded (sex, age, height, weight, waist circumference, blood pressure and body mass index). A fasting blood sample will be collected for insulin, C-peptide, glucose and full lipid profile (total cholesterol, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL)). Insulin resistance is to be calculated using the validated HOMA-IR (homeostasis model of assessment of insulin resistance) method. Participants are asked about the relevant past medical history (medically diagnosed diabetes, dyslipidaemia, hypertension, ischaemic heart disease, cerebrovascular disease or peripheral vascular disease) and medications. At capsule endoscopy gastric emptying and small bowel transit time are recorded as well as whether complete small bowel transit occurs and any pathology encountered. All capsule endoscopy studies will be interpreted by an experienced clinician. Standard capsule endoscopy techniques are to be followed. Patient information is to be de-identified before statistical analysis. No individually identifiable information will be included in the final results.

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