Abstract
Background and Study Aims: At many centers wireless capsule endoscopy (WCE) without prior radiographic examination
to rule out relevant strictures is considered to be contraindicated in suspected obstructive
small-bowel disease. However, the accuracy of radiography in this situation has often
been questioned. The purpose of this prospective study was to investigate the feasibility
and safety of the recently developed patency capsule, and its predictive value regarding
the clinical relevance of radiographic small-bowel strictures.
Patients and Methods: 22 patients with suspected obstructive small-bowel disease and/or radiological evidence
of small-bowel strictures underwent a patency capsule examination. Intact passage,
patient experience of pain, and capsule disintegration were correlated with radiographic
findings, clinical variables, and outcome.
Results: 13 patients passed an intact capsule without complaints, despite radiographically
observed small-bowel stenosis; the subsequent video capsule examination was uneventful
in all. In nine patients either intact passage was painful or the capsule disintegrated;
in one of these, impaction of an intact capsule led to an ileus and emergency surgery.
The type of capsule passage did not correlate with radiographic presence of a stricture,
underlying diagnosis, or previous surgery. There was a statistically significant correlation
between outcome (surgery performed or recommended) and occurrence of painful capsule
passage and disintegration (P ≤ 0.05).
Conclusions: Painless egestion of an intact patency capsule indicates safety of WCE. Patients
without obstructive symptoms require neither small-bowel radiography nor a patency
capsule study prior to WCE. 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.
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M. L. Boivin, M. D.
Department of Gastroenterology, Hepatology and Endocrinology
Campus Charité Mitte · Schumannstraße 20/21 · 10117 Berlin · Germany
Fax: +49-030-450514926·
eMail: mariam.boivin@charite.de
