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. 2024;105(5):373-379.
doi: 10.1159/000539682. Epub 2024 Jun 10.

A Novel Method to Localize Patency Capsule by Ileocolonoscopy Facilitates Endoscopic Assessment of the Small and Large Intestine in Patients with Crohn's Disease

Affiliations

A Novel Method to Localize Patency Capsule by Ileocolonoscopy Facilitates Endoscopic Assessment of the Small and Large Intestine in Patients with Crohn's Disease

Akira Sonoda et al. Digestion. 2024.

Abstract

Introduction: Patients with Crohn's disease (CD) require an assessment of small bowel lesions, while difficulties exist in performing small intestinal examinations, especially in small-sized medical offices. Small bowel capsule endoscopy (SBCE) is handy and can be performed in most clinical settings. The only drawback of SBCE is a requirement of patency testing prior to the exam because it sometimes requires CT scanning to localize the ingested patency capsule (PC), which may be a substantial burden for the patient. We have developed a novel PC detection system named PICS (patency capsule, ileocolonoscopy, and small bowel capsule endoscopy) method by which we can avoid CT scanning. In the PICS method, ileocolonoscopy (ICS) is performed after 30-33 h of PC ingestion and the PC can be localized by ICS in patients who have not excreted the PC, and the entire intestine can be examined in combination with subsequent SBCE without additional bowel preparation. The aim of this study was to assess the usefulness and safety of the PICS method for CD patients.

Methods: CD patients who underwent PICS method from April 2021 to March 2023 were reviewed for clinical data, outcome of PICS method including the rates of PC detection by ICS, the number of patients underwent SBCE, and adverse events. Lewis score was used to assess SBCE results.

Results: The PICS method was performed in 54 patients. The median age of patients was 28.5 years old, and 64.8% of them were ileocolic type. The median disease duration was 10.5 months and 24.1% had history of small bowel resection. Five cases (9.3%) confirmed gastrointestinal patency by ICS, and none of the cases required CT scanning. One patient who could not be confirmed patency by ICS, and the other patient who excreted PC but was found ileal stenosis by ICS did not undergo SBCE. Remaining 52 patients received SBCE, and the median Lewis score of them was 0 (IQR 0, 450). There were no adverse events including small bowel obstruction by PC and SBCE retention in this series.

Conclusion: The PICS method is not only feasible and safe but also convenient to assess disease extent in patients with CD. By localizing PC with ICS, additional CT scanning could be unnecessary for SBCE, which benefits both physicians and CD patients.

Keywords: Crohn’s disease; Ileocolonoscopy; Patency capsule; Small bowel capsule endoscopy.

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Conflict of interest statement

There are no financial and other conflicts of interest to disclose.

Figures

Fig. 1.
Fig. 1.
The flowchart of the PICS method. Patients who could not confirm patency capsule (PC) excretion took plain X-ray to see if the PC remained in the body. Patients who reported PC excretion or was confirmed absence of PC in their body by X-ray underwent ileo-colonoscopy (ICS) followed by small bowel capsule endoscopy (SBCE). Those who detected PC by plain X-ray received ICS to evaluate gastrointestinal patency.
Fig. 2.
Fig. 2.
A representative case of PICS method. A patient status post-ileocecal resection. a Plain X-ray shows patency capsule (PC) in right lower abdomen. b–d PC was found at the vicinity of ileocolic anastomosis. The PC just came out from the ileum passing through the anastomosis observed by ileocolonoscopy (ICS). e Small bowel capsule endoscopy (SBCE) was safely performed subsequently to ICS.
Fig. 3.
Fig. 3.
Method used to confirm gastrointestinal (GI) patency. None of the cases required computed tomography (CT) evaluation. Nine percent of the PICS method confirmed GI patency by ileocolonoscopy (ICS). Plain X-ray was used only to check whether patency capsule (PC) was still in the body or had been excreted already without notice.
Fig. 4.
Fig. 4.
The two our cases unable to pursue SBCE in PICS method. a The patient who was not confirmed gastrointestinal patency. Patency capsule (PC) was thought to be at ileocolic anastomotic area. b The PC could not be detected by ileocolonoscopy. c The other patient confirmed gastrointestinal patency, as the PC was absent in plain X-ray 30 h of PC ingestion. Subsequent ICS demonstrated ileal stenosis with ulcerations.

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