Premature dissolution of the Agile patency device: implications for capsule endoscopy

Abstract

BackgroundThe main risk of capsule endoscopy is retention of the capsule behind a stricture. Passage of an intact Agile patency device (Medtronic, Dublin, Ireland) through the small bowel is widely used to ensure luminal patency, although capsule retention has occurred in patients who have had a reassuring patency study. The device is designed to remain intact for at least 30 hours postingestion, such that loss of signal from the radiofrequency identification tag contained within, or absence of the device on radiological imaging, implies unimpeded intestinal transit.AimTo identify the rate of premature dissolution (<30 hours postingestion) of the Agile patency device.MethodsOutcomes of all consecutive patients having an Agile patency device were analysed.ResultsPremature dissolution of the patency device occurred in 5 of 307 patients, an incidence of 1.3%. This was recognised by the detection of a persistent radiofrequency signal after radiological imaging had failed to identify the patency device, prompting a careful search for the radiofrequency tag on the CT scout film. The tag was difficult to detect because of an oblique lie making it appear smaller than its 13×3 mm size and confusion with intra-abdominal or other metallic fragments.ConclusionsIn the absence of radiological evidence of an intact Agile patency device, premature dissolution should be suspected in patients registering a persistent radiofrequency signal and confirmed by identifying the radiofrequency identification tag. Failure to do so might result in false reassurance that capsule endoscopy could be performed without risk of retention.

A case of incorrect evaluation of intestinal patency by early dissolution of a patency capsule

“…In addition, early dissolution within 30 h in Agile PC is reported to be at a rate of 1.3%, suggesting that it may be influenced by the quality of the PC itself. 9 As a follow-up evaluation, we referred the PC patency evaluation to two capsule endoscopy specialists. We presented them with only the standing radiographic images obtained 24 h after PC ingestion.…”

“…Plain abdominal radiography within 30‐h post‐ingestion showed no opaque PC, but the PC might have remained in the body because of premature dissolution caused by high exposure to intestinal fluid. In addition, early dissolution within 30 h in Agile PC is reported to be at a rate of 1.3%, suggesting that it may be influenced by the quality of the PC itself 9 …”

“…In addition, early dissolution within 30 h in Agile PC is reported to be at a rate of 1.3%, suggesting that it may be influenced by the quality of the PC itself. 9 …”

Modified method of patency judgement using patency capsule prior to capsule endoscopy in clinical practice

“…One of the main purposes of this study was to determine whether ‘estimated patency’ without retesting is valid in identifying patency for SBCE. Premature dissolution of the Agile™ patency device was reported to occur, with at least an incidence of 1.3% in Europe, possibly the cause of unexpected capsule retention 26 . This event was recognised by the detection of a persistent radiofrequency signal after radiological imaging had failed to identify the patency device.…”

Usefulness of patency capsule prior to small-bowel capsule endoscopy in clinical practice: Validity of the modified method of patency judgement

“…One of the main purposes of this study was to determine whether 'estimated patency' without retesting is valid in identifying patency for SBCE. Premature dissolution of the Agile TM patency device was reported to occur, with at least an incidence of 1.3% in Europe, possibly the cause of unexpected capsule retention [24]. This event was recognised by the detection of a persistent radiofrequency signal after radiological imaging had failed to identify the patency device.…”