At many centers, wireless capsule endoscopy without prior radiographic examination, is contraindicated in suspected obstructive small-bowel disease.
However, the accuracy of radiography in this situation has often been questioned.
Dr Boivin and colleagues from Germany conducted a prospective study in 22 patients with suspected obstructive small-bowel disease and/or radiological evidence of small-bowel strictures.
The researchers investigated the feasibility and safety of the recently developed patency capsule.
The research team also investigated the predictive value of patency capsule regarding the clinical relevance of radiographic small-bowel strictures.
The patients underwent a patency capsule examination.
Intact passage, patient experience of pain, and capsule disintegration were correlated with radiographic findings, clinical variables, and outcome.
The researchers found that 13 patients passed an intact capsule without complaints, despite radiographically observed small-bowel stenosis.
|In 9 of 13 patients either intact passage was painful or the capsule disintegrated |
The team noted that the subsequent video capsule examination was uneventful in all.
In 9 patients either intact passage was painful or the capsule disintegrated; in 1 of these, impaction of an intact capsule led to an ileus and emergency surgery.
The research team noted that type of capsule passage did not correlate with radiographic presence of a stricture, underlying diagnosis, or previous surgery.
The team observed a significant correlation between surgery performed or recommended, and occurrence of painful capsule passage and disintegration.
Dr Boivin's team concluded, “Painless egestion of an intact patency capsule indicates safety of wireless capsule endoscopy.”
“Patients without obstructive symptoms require neither small-bowel radiography nor a patency capsule study prior to wireless capsule endoscopy”
“Disintegration of the patency capsule or painful passage seems to be associated with a clinically relevant small-bowel stricture and with a high probability of surgery.”