OBSCURE 2 PC PC
Our data indicates that a VCE could safely be performed even if the PC excretion time is longer than 30 hours and the excreted PC was not screened for damage. Video capsule endoscopy (VCE) is a well-established diagnostic tool in small bowel diagnostics. The main indications are obscure gastrointestinal bleeding, suspected isolated small bowel Crohn's disease, complicated celiac disease, and surveillance in polyposis syndromes. It is a noninvasive diagnostic tool with only rare adverse events. The most important but still rare complication is capsule retention (CR). CR is defined as a remaining of the capsule in the gastrointestinal (GI) tract for longer than two weeks or the need for surgical removal due to small bowel obstruction. Until now only few cases of symptomatic capsule retention have been described. The main risk factor for CR is known or suspected Crohn's disease with a risk of up to 13% in some studies. In patients with symptomatic small bowel obstruction the risk increases to over 16%. Further risk factors include NSAID enteropathy, extensive previous abdominal surgery, intestinal ischemia, volvulus, and a history of abdominal radiotherapy. However, some of these may not be known before VCE.
To minimize the risk of retention in patients with risk factors for CR a PillCam patency capsule (GIVEN Imaging, Ltd., Yokneam, Israel) has been developed. The PC is a self-dissolving dummy capsule with the same size as the VCE. The capsule is made mainly of barium sulphate and lactose anhydrous. It contains a so called radiofrequency identification (RFID), which can be detected via an extracorporeal RFID scanner. 30 hours after ingestion a built-in timer opens two small holes in the capsule's surface. The digestive juice can enter the capsule and starts to dissolve the capsule, thus, preventing small bowel obstruction potentially caused by the PC. So far, only a few cases of continued retaining of the PC or temporary intestinal occlusion have been reported. Īccording to the company, capsule retention of the VCE is most unlikely, if the PC has passed the intestinal tract within 30 hours or if the excreted capsule is still intact without signs of disintegration. Studies showed that the sensitivity of the PC in detecting a stenosis is at least comparable to other diagnostic tools such as barium small bowel follow-through (SBFT) or CT or MRI small bowel imaging in patients with known risk factors for CR. A large multicenter study with 106 patients indicated that even if a stricture is radiologically diagnosed via CT or SBFT, no CR occurred during VCE when the PC was excreted undamaged after more than 30 hours. The average total intestinal transit time of the PC in this study was 40 hours. Forty-three patients excreted the capsule within 60 hours after ingestion.
In this case the manufacturer demands the PC to be investigated for damage.
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