Patency testing prior to Video Capsule Endoscopy: An Irish Experience

Aims Capsule retention, a rare but significant complication of Video Capsule Endoscopy (VCE), occurs in 1-2% of patients [1] [2], depending on indication [3] [4].

Patency Capsules (PC) are dissolvable radio-opaque capsules which assess GI tract patency & effectively identify patients with retention risk [5]. ESGE recommends PC prior to VCE in certain conditions [6]. Our aim was to assess PC protocols in use & the factors affecting outcomes across Ireland.

Methods Procedural data: VCE & PC Indication, Local protocols & Success rates were collected retrospectively from 5 tertiary centres. Demographics & Radiological results were collected from the electronic patient record and analysed using appropriate statistical analysis.

Results 364 procedures were reviewed. 212 (58%) were female, mean age=48 years. VCE indications: Suspected IBD 115 (34%), IBD assessment 82 (24%), IDA/GI Bleeding 62(20%), Low Risk Symptoms 33 (10%), Abnormal Imaging 15 (4%).

PC indications: GI Surgery 68 (20%), Known Crohn’s 72 (21%), Obstructive Symptoms 52 (15%), Stenosis on Imaging 33 (10%), NSAIDs 30 (9%).

81 Patients (23%) did not have valid PC indication per ESGE guidelines.

Overall, 77 patients (21%) were fasted. 184 (51%) Passed (Mean age=49, 53% female). Another 32 (10%) proceeded to CE despite ‘failure’.

Age, Gender & Fasting were not predictors of PC passage (p=0.4126, p=0.2032, p=0.4441). Pass rates were similar in all centres (X² = 7.3.647, p=0.66733). Analysis of pass rate by VCE indication (X²=13.354, p=0.639) and PC indication (X²=7.86, p=0.2482) also failed to show significance.

Conclusions There are similar completion rates for PC across Ireland, and for Age, Gender and PC/VCE indication. This is surprising as we know transit time slows with age.

Fasting does not appear necessary for PC.

Similar completion rates for patients with a valid ESGE PC indications and without, likely represents a high false negative rate. We recommend the introduction of 3D imaging to accurately assess location & increase PC pass rate.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Rondonotti E, Spada C, Adler S. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018; 50 (04) 423-446
• 2 Spada C, Spera G, Riccioni M. et al. A novel diagnostic tool for detecting functional patency of the small bowel: the Given patency capsule. Endoscopy 2005; 37: 793-800
• 3 Rezapour M, Amadi C, Gerson LB.. Retention associated with video capsule endoscopy: systematic review and meta-analysis. Gastrointest Endosc 2017; 85 (06) 1157-1168 e1152
• 4 Liao Z, Gao R, Xu C, Li ZS.. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 2010; 71 (02) 280-6
• 5 Enns RA, Hookey L, Armstrong D. et al. Clinical practice guidelines for the use of video capsule endoscopy. Gastroenterology. 2017; 152 (03) 497-514
• 6 Nemeth A, Wurm Johansson G, Nielsen J, Thorlacius H, Toth E.. Capsule retention related to small bowel capsule endoscopy: a large European single-center 10-year clinical experience. United European Gastroenterol J 2017; 5 (05) 677-686

Publication History

Article published online:
15 April 2024