Gastrointestinal Transit Time Assessed Using a CT-Based Radiopaque Marker Method in Patients With Acute Pancreatitis During Methylnaltrexone Treatment.

INTRODUCTION

Dysmotility is common in acute pancreatitis (AP) and may be evaluated using radiopaque markers and imaging. We present a simple CT-based approach, which was employed in hospitalized patients with AP.

METHODS

This was a secondary analysis of a randomized, controlled trial conducted at four Danish centers. Patients admitted with AP and systemic inflammatory response syndrome were randomized to receive 5 days of intravenous methylnaltrexone or placebo (lactated ringer) added to standard management. Self-reported stool frequency was documented daily. Patients ingested a capsule containing 10 radiopaque markers on Day 3. A subsequent CT scan on Day 5 was used to identify the location of retained markers for the calculation of gastrointestinal transit, and colonic dimensions (diameters and cross-sectional areas) were measured.

RESULTS

In total, 47 patients were included. Patients receiving methylnaltrexone less often had laxative treatment (57% vs. 88%, p = 0.01) compared with placebo. Transit times were similar between the methylnaltrexone and the placebo groups (difference, -4 h (95% CI, -16 to 8), p = 0.53). Marker retention scores, colon diameters, and colon cross-sectional areas did not differ between treatment groups (all p > 0.05). Transit times (ρ = -0.53; p < 0.001), marker retention scores (ρ = -0.42; p = 0.004), diameter (ρ = -0.43; p = 0.003), and cross-sectional areas (ρ = -0.36; p = 0.01) of the descending colon were negatively correlated with self-reported stool frequency.

CONCLUSION

Our CT-based method was feasible in hospitalized patients with AP. Methylnaltrexone did not change gastrointestinal transit compared with placebo. However, laxative therapy was more frequent with the placebo.