Performance of the patency capsule compared with nonenteroclysis radiologic examinations in patients with known or suspected intestinal strictures

Short article: Negative small-bowel cross-sectional imaging does not exclude capsule retention in high-risk patients

“…According to previous studies [1,2,5,15,17], the local investigators categorized patients as having a high or a low risk (HR or LR) of CR. Patients were deemed to be at HR of CR if they fulfilled at least one of the following clinical criteria: severe recurrent abdominal pain with obstructive features, previous small-bowel surgery, chronic long-term high-dose NSAID usage, imaging techniques (i.e.…”

“…Nevertheless, PC has some limitations: it is not compatible with all commercially available SBCEs, it requires monitoring over time (by abdominal plain radiography, cross-sectional radiology or a dedicated radiofrequency scanner), it may be difficult to be localized by plain abdominal radiography [10,11], it can cause acute obstruction [12,13] and, last but not the least, it is not reimbursed. Therefore, small-bowel crosssectional imaging (SBCSI) techniques, which are easily accessible and reimbursed, are now extensively performed in clinical practice to rule out small-bowel luminal stenosis before SBCE [14,15]. The recently released American College of Gastroenterology clinical guidelines on smallbowel bleeding [16] recommend computed tomography (CT) enterography before SBCE in patients with an increased risk of CR.…”

“…Studies comparing PC and SBCSI are few, mostly coming from referral centres, [14,15] and it is still unclear whether SBCSI and PC are equivalent and which modality should be preferred in a routine practice setting. To address this issue, we compared the capsule retention rate (CRR) in a large cohort of patients at an increased risk for CR receiving either PC or SBCSI before SBCE.…”

Small Bowel Capsule Endoscopy

“…Conventional radiological imaging methods such as barium contrast radiography and CT or magnetic resonance enterography (using oral contrast) may be used. Whilst negative studies suggest that the capsule will most likely pass without incident [391], significant stenoses can be missed [286,369,374,[392][393][394][395]. Enteroclysis techniques using nasojejunal intubation to distend the small bowel have been shown to more accurately detect intestinal strictures in patients with Crohn's disease [396]; however, they may miss diaphragmatic webs associated with NSAID enteropathy [373].…”

“…Enteroclysis techniques using nasojejunal intubation to distend the small bowel have been shown to more accurately detect intestinal strictures in patients with Crohn's disease [396]; however, they may miss diaphragmatic webs associated with NSAID enteropathy [373]. In addition, this test is time consuming, uncomfortable for the patient and thus less commonly available [391]. An alternative and increasingly used approach to establish patency of the small bowel in patients with a high risk of retention is the use of the Pillcam Patency test (Given Imaging Ltd).…”