Small bowel patency assessment using the patency device and a novel targeted (limited radiation) computed tomography‐based protocol

Assadsangabi, Arash; Blakeborough, A.; Drew, K; Lobo, Alan; Sidhu, Reena; McAlindon, Mark E.

doi:10.1111/jgh.12891

Cited by 26 publications

(24 citation statements)

References 15 publications

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“…This cannot be done with confidence on a plain abdominal film and conventionally has been achieved using either fluoroscopy or whole abdominal CT scan, both of which require considerable organisation, out-of-hours procedures and substantial irradiation. Our protocol includes the use of a scout film, used to target a limited abdominal CT scan (which involves minimal radiation exposure) to localise the exact position of the patency device and determines luminal patency with a sensitivity of 99.4% 20. Of 400 high-risk patients undergoing the patency protocol, only one (0.6%) retained a capsule after a limited CT scan was incorrectly reported as showing the PillCam patency in the colon.…”

Section: Practical Considerationsmentioning

confidence: 99%

Practical aspects of delivering a small bowel endoscopy service in the UK

Hale

Davison

Panter

et al. 2015

Frontline Gastroenterol

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Capsule endoscopy remains at the forefront of small bowel investigation, offering the only non-invasive means of directly imaging the mucosa of the small bowel. Recommended for the investigation of obscure gastrointestinal bleeding, Crohn's disease, coeliac disease, small bowel tumours and hereditary polyposis syndromes, the uptake of small bowel capsule endoscopy has been widespread in the UK. However, despite a wealth of published literature supporting the utility of capsule endoscopy in clinical practice, there are limited data regarding the actual practical aspects of service delivery, training and quality assurance. In this article, we attempt to address this by considering specific factors that contribute to provision of a high-quality capsule service. The role of formal training, accreditation and quality assurance measures is also discussed.

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Section: Practical Considerationsmentioning

confidence: 99%

Practical aspects of delivering a small bowel endoscopy service in the UK

Hale

Davison

Panter

et al. 2015

Frontline Gastroenterol

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“…No restrictions, dietary or otherwise, were imposed during this time. A radiofrequency scan was performed and, if a signal persisted, patients were referred for a limited CT scan that afternoon as previously described 11. In the absence of a radiofrequency signal, or following identification of the patency device in the colon on CT scan (figure 2), capsule endoscopy was performed.…”

Section: Methodsmentioning

confidence: 99%

“…In June 2017, a patient was referred to the radiology department as per the usual unit protocol,11 having registered a radiofrequency signal at 14:00 hours, 30 hours after swallowing an Agile patency device. The protocol was developed in collaboration with our gastrointestinal radiologists who report all films.…”

Section: Methodsmentioning

confidence: 99%

Premature dissolution of the Agile patency device: implications for capsule endoscopy

Wray

Healy

Thurston

et al. 2018

Frontline Gastroenterol

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BackgroundThe main risk of capsule endoscopy is retention of the capsule behind a stricture. Passage of an intact Agile patency device (Medtronic, Dublin, Ireland) through the small bowel is widely used to ensure luminal patency, although capsule retention has occurred in patients who have had a reassuring patency study. The device is designed to remain intact for at least 30 hours postingestion, such that loss of signal from the radiofrequency identification tag contained within, or absence of the device on radiological imaging, implies unimpeded intestinal transit.AimTo identify the rate of premature dissolution (<30 hours postingestion) of the Agile patency device.MethodsOutcomes of all consecutive patients having an Agile patency device were analysed.ResultsPremature dissolution of the patency device occurred in 5 of 307 patients, an incidence of 1.3%. This was recognised by the detection of a persistent radiofrequency signal after radiological imaging had failed to identify the patency device, prompting a careful search for the radiofrequency tag on the CT scout film. The tag was difficult to detect because of an oblique lie making it appear smaller than its 13×3 mm size and confusion with intra-abdominal or other metallic fragments.ConclusionsIn the absence of radiological evidence of an intact Agile patency device, premature dissolution should be suspected in patients registering a persistent radiofrequency signal and confirmed by identifying the radiofrequency identification tag. Failure to do so might result in false reassurance that capsule endoscopy could be performed without risk of retention.

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“…If the location of the PC is uncertain, it is possible to demonstrate its position using abdominal CT. 68 In a recent study that evaluated the accuracy of plain abdominal radiology for the localization of the retained PC (confirmed by a radiofrequency scanner), a definite assessment of the location was possible in only 26% of the patients using a plain abdominal film; a specialized limited CT protocol was significantly more accurate (positive and negative predictive values of 99.7% and 81%, respectively). 69 The excretion rate of the PC varies between 45% and 93%, 65,67,70-72 depending on patient selection. In a series of 77 CD patients who underwent a PC examination before proceeding to diagnostic VCE, the PC was not excreted within 30 hours in 7.8% of the patients.…”

Section: Patency Capsulementioning

confidence: 99%

Video Capsule Endoscopy of the Small Bowel for Monitoring of Crohnʼs Disease

Kopylov

Ben‐Horin

Seidman

et al. 2015

Inflammatory Bowel Diseases

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Video capsule endoscopy has revolutionized our ability to visualize the small bowel mucosa. This modality is a valuable tool for the diagnosis of suspected small bowel Crohn's disease, and it is increasingly used for the monitoring of disease activity in patients with established small bowel Crohn's. The purpose of the current article was to review the literature pertaining to the utilization of capsule endoscopy in established Crohn's disease, for monitoring of mucosal healing, postoperative recurrence, disease classification, and other indications.

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Small bowel patency assessment using the patency device and a novel targeted (limited radiation) computed tomography‐based protocol

Abstract: Excretion of the PC 30 h post-ingestion reliably predicts safe CE passage. Plain abdominal radiology is unreliable and a scout film targeted, limited CT scan offers an accurate minimal radiation method of determining small bowel patency.

Cited by 26 publications

References 15 publications

Practical aspects of delivering a small bowel endoscopy service in the UK

Practical aspects of delivering a small bowel endoscopy service in the UK

Premature dissolution of the Agile patency device: implications for capsule endoscopy

Video Capsule Endoscopy of the Small Bowel for Monitoring of Crohnʼs Disease

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