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AUGMENTED PRO-MOTILITY PROTOCOL FOR PATIENTS WHO PREVIOUSLY FAILED PATENCY CAPSULE IS SAFE AND EFFECTIVE

Tom Borkovksy 1,2, Tamar Thurm 2,1, Nitsan Maharshak 2,1, Liat Deutsch 2,1

Affiliations

1 Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

2 Tel Aviv University, Tel Aviv, Israel

Summary

AI Generated

A prospective cohort study of 396 patients evaluated an augmented pro-motility preparation protocol for second patency capsule attempts in patients who failed initial testing before video capsule endoscopy.

Of 73 patients who failed initial patency capsule testing, 35 underwent a second attempt with augmented pro-motility preparation (bisacodyl plus PEG 3350 added to standard protocol), achieving 57% success rate with no adverse events.
The second attempt reduced the overall failed patency capsule rate by 57% absolute risk reduction with a number needed to treat of 1.8.
All 20 patients with successful second patency capsule attempts completed subsequent video capsule endoscopy without complications, and three patients with failed second attempts had false-positive results confirmed by CT showing capsule in colon.
Diabetes mellitus showed a trend as a risk factor for patency capsule failure (OR 3.7, p=0.057), though multivariate analysis was limited by small numbers.
This material is most relevant to gastroenterologists managing patients requiring video capsule endoscopy, particularly those with suspected Crohn's disease (86.1% of study indications).

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

A patency capsule (PC) test is advised before video capsule endoscopy (VCE) to prevent capsule retention in high-risk patients. Although up to 30% of patients cannot expel the PC within 30 hours and are ineligible for VCE, those without strictures, but with slow transit time, can safely undergo VCE. Currently there are no recommendations regarding PC protocol.

Aims & Methods

In this prospective cohort study, we aimed to evaluate the success rate of a 2^nd PC attempt with augmented pro-motility preparation protocol, in patients who previously failed to pass PC and to ascertain the risk factors for failure in PC test.

During 2019-2023, Patients who failed their initial PC test in our referral center were offered to undergo a 2^nd augmented pro-motility bowel preparation protocol (Table 1). Exclusion criteria: age<18 years, total colectomy or ileostomy and inability to sign informed consent. Patients were followed during the 2^nd PC test and the subsequent VCE for success rates and safety outcomes, i.e. VCE retention. Demographic and clinical characteristics were collected for assessing potential risk factors for 1^st PC failure and successful 2^nd PC by multivariate regression analysis.

Results

A total of 396 patients performed a PC test and were included in the study (age 45.4±18.6 years, male gender 47.7%). The indications for VCE were suspected/established Crohn's disease (86.1%); anemia/bleeding (8.3%) and radiologic findings (5.6%). Successful PC expulsion was documented in 323 (81.6%) patients, while 73 (18.4%) failed. A 2^nd attempt with augmented pro-motility protocol was accepted by 35/73 patients (48%) and rejected by 38/73 patients (52%). no clinico-demographic differences between the groups. Successful 2^nd PC attempt was documented in 20/35 patients (57%), with all of them completing VCE without adverse events. Failed 2^nd PC was documented in 15/35 patients (43%) without adverse events, while 3/15 performed tandem abdominal CT confirming PC in colon (i.e false failure) followed by uneventful VCE.

Performance of a 2^nd PC attempt reduced the failed PC rate by 57% (Absolute risk reduction) and the number needed to treat (NNT) is 1.8 for a successful 2^nd attempt. Multivariate regression for success with 2^nd PC vs. 1^st PC was limited by small numbers. However, diabetes mellitus showed a trend as a risk factor (9.6% in 1^st PC test success vs. 20% in 2^nd PC test success, OR 3.7, p=0.057, adjusted for age, gender, BMI and stools/day).

Conclusion

In this prospective cohort study, a novel augmented pro-motility PC test preparation protocol improved the success rate in patients who previously failed an initial PC test, without any adverse events. Subsequent abdominal CT should be considered in selected cases to further reduce false positive results. Patients with diabetes mellitus might benefit from performing the augmented protocol upfront, but further large-scale studies are required to establish that.

Table 1: Patency Capsule Preparation Protocols

		Pro-motility protocol 1^st PC	Augmented pro-motility protocol 2^nd PC
-2 day	All day	Low residue diet
-1 day	12:00-20:00	Clear liquid diet
	14:00	-	Bisacodyl 10mg
	19:00-21:00	-	PEG 3350 1.5L
	20:00-till PC ingestion	Fasting
PC day	Morning	PC ingestion + Bisacodyl 10mg
	2hours post-ingestion	Drink clear liquids
	4 hours post ingestion	A light meal
+1 day	30 hours post ingestion	X-ray or confirmed expulsion

PC, patency capsule; PEG3350, Poly-ethylene Glycol

Disclosure

Nothing to disclose

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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