Symptomatic retention of the patency capsule: a multicenter real life case series

Background and aims: The patency capsule is designed to evaluate the patency of the small bowel before administration of small-bowel capsule endoscopy (SBCE) in patients at high risk of retention. The utilization of a patency capsule may be associated with a risk of symptomatic retention, but very few cases have been reported to date. The aim of our study was to describe our experience with this rare complication of a patency capsule.

Methods: This was a multicenter retrospective case series. The medical records of patients who underwent a patency capsule test were scanned and all cases of symptomatic retention were collected.

Results: In total, 20 symptomatic cases of retention out of 1615 (1.2 %) patency capsule tests were identified; in one patient, the patency capsule was retained in the esophagus, in the rest, the capsule was detected in the small bowel resulting in abdominal pain or small-bowel obstruction. One patient (5 %) required surgery; all other patients resolved spontaneously or after corticosteroid therapy.

Conclusions: Symptomatic patency capsule retention is a very rare complication with a favorable prognosis. It should be recognized but its use in patients with suspected small-bowel stenosis should not be discouraged.

^* These authors contributed equally.

• References

• 1 Pennazio M, Spada C, Eliakim R et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352-376
• 2 Kopylov U, Yablecovitch D, Lahat A et al. Detection of small bowel mucosal healing and deep remission in patients with known small bowel Crohn’s disease using biomarkers, capsule endoscopy, and imaging. Am J Gastroenterol 2015; 110: 1316-1323
• 3 Kopylov U, Ben-Horin S, Seidman EG et al. Video capsule endoscopy of the small bowel for monitoring of Crohn’s disease. Inflamm Bowel Dis 2015; 21: 2726-2735
• 4 Greener T, Klang E, Yablecovitch D et al. The impact of magnetic resonance enterography and capsule endoscopy on the re-classification of disease in patients with known Crohn’s disease: A prospective Israeli IBD Research Nucleus (IIRN) study. J Crohns Colitis 2016; 10: 525-531
• 5 Kopylov U, Seidman EG. Clinical applications of small bowel capsule endoscopy. Clin Exp Gastroenterol 2013; 6: 129-137
• 6 Cave D, Legnani P, de Franchis R et al. ICCE consensus for capsule retention. Endoscopy 2005; 37: 1065-1067
• 7 Annese V, Daperno M, Rutter MD et al. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 2013; 7: 982-1018
• 8 Nemeth A, Kopylov U, Koulaouzidis A et al. Use of patency capsule in patients with established Crohn’s disease. Endoscopy 2016; 48: 373-379
• 9 Mow WS, Lo SK, Targan SR et al. Initial experience with wireless capsule enteroscopy in the diagnosis and management of inflammatory bowel disease. Clin Gastroenterol Hepatol 2004; 2: 31-40
• 10 Cheifetz AS, Kornbluth AA, Legnani P et al. The risk of retention of the capsule endoscope in patients with known or suspected Crohn’s disease. Am J Gastroenterol 2006; 101: 2218-2222
• 11 Kopylov U, Nemeth A, Koulaouzidis A et al. Small bowel capsule endoscopy in the management of established Crohn’s disease: Clinical impact, safety, and correlation with inflammatory biomarkers. Inflamm Bowel Dis 2015; 21: 93-100
• 12 Niv E, Fishman S, Kachman H et al. Sequential capsule endoscopy of the small bowel for follow-up of patients with known Crohn’s disease. J Crohns Colitis 2014; 8: 1616-1623
• 13 Hall BJ, Holleran GE, Smith SM et al. A prospective 12-week mucosal healing assessment of small bowel Crohn’s disease as detected by capsule endoscopy. Eur J Gastroenterol Hepatol 2014; 26: 1253-1259
• 14 Hall B, Holleran G, Chin JL et al. A prospective 52 week mucosal healing assessment of small bowel Crohn’s disease as detected by capsule endoscopy. J Crohns Colitis 2014; 8: 1601-1609
• 15 Flamant M, Trang C, Maillard O et al. The prevalence and outcome of jejunal lesions visualized by small bowel capsule endoscopy in Crohn’s disease. Inflamm Bowel Dis 2013; 19: 1390-1396
• 16 Esaki M, Matsumoto T, Watanabe K et al. Use of capsule endoscopy in patients with Crohn’s disease in Japan: a multicenter survey. J Gastroenterol Hepatol 2014; 29: 96-101
• 17 Caunedo-Alvarez A, Romero-Vazquez J, Herrerias-Gutierrez JM. Patency and Agile capsules. World J Gastroenterol 2008; 14: 5269-5273
• 18 Kato S, Osada H, Yakabi K. A rare case of temporary intestinal obstruction induced by the novel tag-less Agile patency capsule in a patient with Crohn’s disease. Dig Endosc 2016; 28: 481
• 19 Herrerias JM, Leighton JA, Costamagna G et al. Agile patency system eliminates risk of capsule retention in patients with known intestinal strictures who undergo capsule endoscopy. Gastrointest Endosc 2008; 67: 902-909
• 20 Liatsos C, Kyriakos N, Panagou E et al. An unusual presentation of obstructive ileus, due to impacted Agile patency capsule, in a patient with Crohn’s disease. Ann Gastroenterol 2011; 24: 65-66
• 21 Delvaux M, Ben Soussan E, Laurent V et al. Clinical evaluation of the use of the M2A patency capsule system before a capsule endoscopy procedure, in patients with known or suspected intestinal stenosis. Endoscopy 2005; 37: 801-807
• 22 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
• 23 Okoli A, Ammannagari N, Mazumder M et al. When the dissolvable does not dissolve: an agile patency capsule mystery. Am J Gastroenterol 2014; 109: 605-607
• 24 Rozendorn N, Klang E, Lahat A et al. Prediction of patency capsule retention in known Crohn’s disease patients using magnetic resonance imaging. Gastrointest Endosc 2016; 83: 182-187
• 25 Boivin ML, Lochs H, Voderholzer WA. Does passage of a patency capsule indicate small-bowel patency? A prospective clinical trial. Endoscopy 2005; 37: 808-815
• 26 Signorelli C, Rondonotti E, Villa F et al. Use of the Given Patency System for the screening of patients at high risk for capsule retention. Dig Liver Dis 2006; 38: 326-330
• 27 Banerjee R, Bhargav P, Reddy P et al. Safety and efficacy of the M2A patency capsule for diagnosis of critical intestinal patency: results of a prospective clinical trial. J Gastroenterol Hepatol 2007; 22: 2060-2063
• 28 Spada C, Shah SK, Riccioni ME et al. Video capsule endoscopy in patients with known or suspected small bowel stricture previously tested with the dissolving patency capsule. J Clin Gastroenterol 2007; 41: 576-582
• 29 Postgate AJ, Burling D, Gupta A et al. Safety, reliability and limitations of the given patency capsule in patients at risk of capsule retention: a 3-year technical review. Dig Dis Sci 2008; 53: 2732-2738
• 30 Cohen SA, Gralnek IM, Ephrath H et al. The use of a patency capsule in pediatric Crohn’s disease: a prospective evaluation. Dig Dis Sci 2011; 56: 860-865
• 31 Yadav A, Heigh RI, Hara AK et al. Performance of the patency capsule compared with nonenteroclysis radiologic examinations in patients with known or suspected intestinal strictures. Gastrointest Endosc 2011; 74: 834-839
• 32 Shiotani A, Hata J, Manabe N et al. Clinical relevance of patency capsule combined with abdominal ultrasonography to detect small bowel strictures. Eur J Gastroenterol Hepatol 2014; 26: 1434-1438
• 33 Nakamura M, Hirooka Y, Yamamura T et al. Clinical usefulness of novel tag-less Agile patency capsule prior to capsule endoscopy for patients with suspected small bowel stenosis. Dig Endosc 2015; 27: 61-66
• 34 Assadsangabi A, Blakeborough A, Drew K et al. Small bowel patency assessment using the patency device and a novel targeted (limited radiation) computed tomography-based protocol. J Gastroenterol Hepatol 2015; 30: 984-989
• 35 Rommele C, Brueckner J, Messmann H et al. Clinical experience with the PillCam patency capsule prior to video capsule endoscopy: a real-world experience. Gastroenterol Res Pract 2016; 2016: 9657053 (Epub 2016 Jan 6)
• 36 Albuquerque A, Cardoso H, Marques M et al. Predictive factors of small bowel patency in Crohn’s disease patients. Rev Esp Enferm Dig 2016; 108: 65-70