Small bowel enteroclysis with magnetic resonance imaging and computed tomography in patients with failed and uncertain passage of a patency capsule

Abstract

BackgroundVideo capsule enteroscopy (VCE) has revolutionized small bowel imaging, enabling visual examination of the mucosa of the entire small bowel, while MR enteroclysis (MRE) and CT enteroclysis (CTE) have largely replaced conventional barium enteroclysis. A new indication for MRE and CTE is the clinical suspicion of small bowel strictures, as indicated by delayed or non-delivery of a test capsule given before a VCE examination, to exclude stenosis. The aim of this study was to determine the clinical value of subsequent MRE and CTE in patients in whom a test capsule did not present itself in due time.MethodsSeventy-five consecutive patients were identified with a delayed or unnoticed delivery of the test capsule. Seventy patients consented to participate and underwent MRE (44) or CTE (26). The medical records and imaging studies were retrospectively reviewed and symptoms, laboratory results and imaging findings recorded.ResultsLesions compatible with Crohns disease were shown by MRE in 5 patients, by CTE in one and by VCE in four, one of whom had lesions on MRE. In patients without alarm symptoms and findings (weight loss, haematochezia, anaemia, nocturnal diarrheoa, ileus, fistula, abscess and abnormal blood tests) imaging studies did not unveil any such lesion. VCE's were performed in only 20 patients, mainly younger than 50 years of age, although no stenotic lesion was shown by MRE and CTE. In the remaining 50 patients no VCE or other endoscopic intervention was performed indicating that the referring physician was content with the diagnostic information from MRE or CTE.ConclusionThe diagnostic value of MRE and CTE is sufficient for clinical management of most patients with suspected small bowel disease, and thus VCE may be omitted or at least postponed for later usage.

Small bowel patency assessment using the patency device and a novel targeted (limited radiation) computed tomography‐based protocol

“…Alternatives are arguably less desirable: our study suggests that radiologists would request abdominal CT anyway for most patients after reviewing the plain abdominal film, which remains common practice. Other alternatives are likely to be more complicated: a recent study by Fork et al . recommended magnetic resonance enteroclysis (MRE) and CT enteroclysis (CTE) as alternative methods of ensuring safe passage of CE in the subgroup of patients who had an initial PC test with a late or unconfirmed excretion of the capsule.…”

Utility of Computed Tomographic Enteroclysis/Enterography for the Assessment of Mucosal Healing in Crohn's Disease

“…Furthermore, inflammatory lesions might exist outside the reachable range of the colonoscope. Because one of the major limitations of capsule endoscopy is capsule retention, this procedure cannot be undergone by patients with severe stenosis or with failed and uncertain passage of a patency capsule [12]. It is difficult to observe the entire small intestine by balloon endoscopy, and the patient requires conscious sedation during the procedure.…”

Video Capsule Retention in Inflammatory Bowel Disease: An Unusual Presentation and Discussion of Retrieval Methods

“…However, experience with patency capsules has been disappointing, with many patients reporting delayed or nonpassage of the patency capsule [11]. A recent study has shown that CT or MR enterography is sufficient for the investigation of most patients with small bowel disease and VCE can be used as a subsequent investigation if necessary [12]. …”