Capsule Retention in Crohn Disease: A Meta-Analysis

Pasha, S. F.; Pennazio, Marco; Rondonotti, Emanuele; Wolf, Douglas C.; Buras,; Albert, JG; Cohen, SA; Cotter, José; D’Haens, Geert R.; Eliakim, Rami; Rubin, Daniel; Leighton, JA

doi:10.1055/s-0039-1681198

Cited by 4 publications

(2 citation statements)

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“… 8–10 Rezapour et al 9 recently reported in a systematic review and meta‐analysis that the pooled SBCE retention rates without patency assessment for established and suspected CD were 8.2% and 3.6%, respectively, whereas the retention rate for patients with mainly inflammatory bowel disease in studies that used a patency capsule or CT enterography was 2.7%, which was approximately half this rate. Pasha et al 11 stated in the meta‐analysis that SBCE retention rates were 4.63% (95% CI, 3.42%–6.25%) and 2.35% (95% CI, 1.31%–4.19%) in established and suspected CD, respectively, and the retention rates in established CD were decreased after patency capsule testing (2.88%; 95% CI, 1.74%–4.74%) and MR/CT enterography (2.32%; 95% CI, 0.87%–6.03%). They suggested the importance of GI patency evaluation prior to SBCE in established CD.…”

Section: Discussionmentioning

confidence: 99%

Tag‐less patency capsule for suspected small bowel stenosis: Nationwide multicenter prospective study in Japan

Nakamura

Watanabe

Ohmiya

et al. 2020

Digestive Endoscopy

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Study aims: The PillCam patency capsule (PPC) is an Agile tag-less patency capsule used to evaluate gastrointestinal (GI) patency. We determined the appropriate use of PPC to preclude subsequent small bowel capsule endoscopy (SBCE) retention. Methods: This prospective multicenter study consecutively enrolled patients indicated for SBCE with suspected or established small bowel stenosis. Excretion of an intact PPC or its radiologic visualization in the large bowel was considered GI patency. Primary and secondary study endpoints were SBCE retention rates in patients with confirmed patency and identification of factors associated with patency and SBCE retention, respectively. Results: Of 1096 patients enrolled in the study, patency was confirmed in 976 (89.1%). PPC excretion occurred in 579 patients. Of the remaining 517 patients, patency was confirmed using imaging modalities in 401 (77.5%). SBCE retention occurred in five (0.51%) of 963 patients who underwent SBCE: 1.0% in established Crohn's disease (CD) patients, 0% in suspected CD, 0% in tumors, and 1.6% in patients with obscure GI bleeding, for which PPC localization had been radiographically misinterpreted. The non-confirmation of patency was associated with established CD, stenosis identified using imaging modalities, abdominal fullness, serum albumin levels <4.0 g/dL, and previous small bowel obstruction (adjusted odds ratios: 4.

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Section: Discussionmentioning

confidence: 99%

Tag‐less patency capsule for suspected small bowel stenosis: Nationwide multicenter prospective study in Japan

Nakamura

Watanabe

Ohmiya

et al. 2020

Digestive Endoscopy

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“…For the overall CD cohort, retention rates of 3.49% and 1.64% have been reported for adult and pediatric patient populations, respectively. Furthermore, retention risk can be reduced through the use of the patency capsule 53 .…”

Section: Hurdles To Video Capsule Endoscopy Utilizationmentioning

confidence: 99%

Monitoring established Crohn’s disease with pan-intestinal video capsule endoscopy in Europe: clinician consultation using the nominal group technique

Carretero

Carbonnel

Ferrante

et al. 2021

Current Medical Research and Opinion

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Objective: Monitoring established Crohn's disease (CD) through a "treat-to-target" strategy aims to reduce and prevent long-term bowel damage and disability. Despite the availability of different monitoring techniques, there is a current lack of integrated evidence to guide optimal monitoring in terms of appropriate tools and timing. Pan-intestinal video capsule endoscopy (PCE) enables non-invasive and direct visualization of the entire intestinal tract with proven safety and efficacy. This study aims to generate insights on the value of PCE for monitoring established CD from the physician's perspective. Methods: The Nominal Group Technique (NGT) was used to create discussion around pre-defined research questions aimed at identifying target patient populations for PCE, benefits of PCE in terms of improving disease management, comparative benefits of PCE over standard of care, research priorities to ratify the use of PCE, and hurdles to PCE utilization. A NGT panel was held in Brussels, Belgium in October 2018 with 9 gastroenterology experts. Data were collected from multiple rankings of statements to the research questions and analyzed descriptively. Results: Consensus indicated that PCE is differentiated from other diagnostic tools, allowing for noninvasive and direct visualization of the luminal intestinal tract in one single procedure. Participants agreed that PCE is beneficial for mapping and grading established CD in all patients, enabling individual and tailored treatment decision-making. Time required to read PCE results was identified as the main utilization hurdle by participants. Well-designed studies are needed to confirm improved outcomes amongst patients with CD managed through a PCE-guided approach. Conclusions: This study, using the NGT, generated expert opinion on the value of PCE for monitoring established CD in terms of target patient populations and benefits compared to other diagnostic modalities. Participants perceived PCE to facilitate a "treat-to-target" strategy for CD management. Further research is needed to support this value perception.

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Panenteric capsule endoscopy versus ileocolonoscopy plus magnetic resonance enterography in Crohn’s disease: a multicentre, prospective study

Bruining

Oliva

Fleisher

et al. 2020

BMJ Open Gastroenterol

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IntroductionCrohn’s disease diagnosis and monitoring remains a great clinical challenge and often requires multiple testing modalities. Assessing Crohn’s disease activity in the entire gastrointestinal (GI) tract using a panenteric capsule endoscopy (CE) system could be used as an alternative to colonoscopy and cross-sectional imaging. This study assessed the accuracy and safety of panenteric CE in Crohn’s disease as compared with ileocolonoscopy (IC) and/or magnetic resonance enterography (MRE).MethodsA prospective, multicentre study was performed in subjects with established Crohn’s disease. Individuals with proven small bowel patency underwent a standardised bowel preparation, followed by CE ingestion and IC either the same or following day. MRE, IC, and CE interpretations were performed by blinded central readers using validated scoring systems. The primary endpoint was the overall sensitivity of CE vs MRE and/or IC in Crohn’s disease subjects.ResultsStudy enrolment included 158 subjects from 21 sites in the USA, Austria, and Israel. Of those, 99 were included in the analysis. Imaging modality scores indicated none to mild inflammation in the proximal small bowel and colon, but discrepant levels of inflammation in the terminal ileum. Overall sensitivity for active enteric inflammation (CE vs MRE and/or IC) was 94% vs 100% (p=0.125) and specificity was 74% vs 22% (p=0.001). Sensitivity of CE was superior to MRE for enteric inflammation in the proximal small bowel (97% vs 71%, p=0.021), and similar to MRE and/or IC in the terminal ileum and colon (p=0.500–0.625). There were seven serious adverse advents of which three were related to the CE device.ConclusionPanenteric CE is a reliable tool for assessing Crohn’s disease mucosal activity and extent compared with more invasive methods. This study demonstrates high performance of the panenteric CE as compared to MRE and/or IC without the need for multiple tests in non-stricturing Crohn’s disease.Trial registration numberClinicalTrials.gov NCT03241368

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Capsule Retention in Crohn Disease: A Meta-Analysis

Cited by 4 publications

References 0 publications

Tag‐less patency capsule for suspected small bowel stenosis: Nationwide multicenter prospective study in Japan

Tag‐less patency capsule for suspected small bowel stenosis: Nationwide multicenter prospective study in Japan

Monitoring established Crohn’s disease with pan-intestinal video capsule endoscopy in Europe: clinician consultation using the nominal group technique

Panenteric capsule endoscopy versus ileocolonoscopy plus magnetic resonance enterography in Crohn’s disease: a multicentre, prospective study

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