Aine Fitzpatrick

Safety, Reliability and Limitations of the Given Patency Capsule in Patients at Risk of Capsule Retention: A 3-Year Technical Review

Introduction The patency capsule may prevent capsule retention in high-risk patients. However data on its use in routine clinical practice is limited. Methods Patients referred to our institution between Feb-04 and Jan-07 were reviewed. The following data was collected: presenting symptoms; medical/surgical history; medication; radiology; patency/video capsule result; subsequent investigations; clinical outcomes. Results 373 patients were referred. In 315 (84%) ‘low-risk’ patients (no patency capsule): delayed transit occurred in three, with no cases of capsule retention. In 58 (16%) ‘high risk’ patients (patency capsule): asymptomatic retention occurred in eight, all with pathology despite normal prior barium studies in six; in four cases patency location was incorrectly assessed radiologically, leading to video capsule retention and surgery in one. Discussion Most patients can safely undergo capsule endoscopy without a patency capsule. The patency capsule appears safe and is indicative of pathology when retained. Assessment of patency capsule location post ingestion can be difficult, and if barium radiology is equivocal a limited abdominal computed tomography (CT) scan is suggested.

Feasibility of video capsule endoscopy in the management of children with Peutz-Jeghers syndrome: a blinded comparison with barium enterography for the detection of small bowel polyps.

Objectives: Peutz-Jeghers syndrome (PJS) in children may present with anaemia, intussusception, or obstruction from an early age and surgery is common. Prophylactic polypectomy may reduce subsequent complications. Traditional barium enterography (BE) has poor sensitivity and requires significant radiation. We compared the performance of capsule endoscopy (CE) with BE in children with PJS. Materials and Methods: Children with PJS (ages 6.0–16.5 years) were prospectively recruited and underwent BE followed by CE, each reported by expert reviewers blinded to the alternate modality. Number of “significant” (>10 mm) and total number of polyps were recorded. Child preference was assessed using a visual analogue questionnaire. Definitive findings were assessed at laparotomy or enteroscopy, when performed. Results: There was no significant difference for >10 mm polyp detection. Six polyps were found in 3 children by both modalities: 3 polyps in 2 children at CE, 3 polyps in 1 child at BE (P = 0.50). Re-review of 1 CE identified 3 polyps that were missed in 1 child at initial reading. Significantly more <10 mm polyps were identified by CE than BE: 61 vs 6 (P = 0.02). CE was significantly more comfortable than BE (median score CE 76 [interquartile range 69–87] vs BE 37 [interquartile range 31–68], P = 0.03) and was the preferred investigation in 90% (P = 0.02). Conclusions: CE is a feasible, safe, and sensitive test for small bowel polyp surveillance in children with PJS. It is significantly more comfortable than BE and is the preferred test of most children for future surveillance. There is a learning curve for reporting CE studies in PJS and appropriate training is essential.

Should We Be Using Bowel Preparation and Prokinetic Agents for Small Bowel Capsule Endoscopy? A Prospective Randomized Controlled Trial

randomized to PEG, OSPS, or dual (OSPSþPEG) preparations. Subjects with GFR %60 ml/min were not randomized to OSPS or dual preparation. Blood and early morning spot urine were collected 1 wk prior to (v1), on day of (v2) and 1 wk after C (v3) for serum creatinine (Cr, mg/dL), estimated glomerular filtration rate (eGFR, ml/min), phosphorous (P, mg/dL), calcium (Ca, mg/dL) with urinary P, creatinine, and N-acetyl-Dglucosaminidase (NAG, IU/mg of creatinine), a lysosomal enzyme released in urine after tubular injury. Effect on renal function was assessed by absolute change in Cr, percent change in Cr and eGFR at v2 and v3 compared to v1. Results: A total of 165 subjects (AB Z 139; mean age: 58 1 y and SCI Z 26; mean age: 60 2y; p Z 0.3) were analyzed. Bowel preparation was achieved with PEG in 55 (AB Z 47; SCI Z 8), OSPS in 55 (AB Z 47; SCI Z 8), and dual in 56 (AB Z 46; SCI Z 10) subjects. In AB subjects, Cr at v2 increased with OSPS (0.9 0.2 to 0.94 0.3) and dual (0.9 0.2 to 0.91 0.2) preparation, but decreased in SCI subjects (0.7 0.2 to 0.6 0.2) and returned to baseline by v3. Absolute change in Cr at v2 was higher in AB subjects compared to SCI with OSPS (0.01 0.02 vs -0.09 0.03, p ! 0.04) and dual (0.04 0.03 vs. -0.1 0.05, p ! 0.07). Percent change in Cr was higher with OSPS (2.1 2.2 vs -12 4.6, p ! 0.01) and dual (4 3.4 vs. -12 6.3, p ! 0.03) but not with PEG (2.1 2.2 vs. -12 4.5, p O 0.1). Changes in eGFR paralleled Cr changes. In AB subjects, OSPS increased serum P (3.2 0.5 to 5.7 1.7, p ! 0.0001), urinary P (67 6 to 405 40, p ! 0.0001), urinary NAG (0.4 0.05 to 0.6 0.1, p ! 0.02) and decreased serum Ca (9.2 0.4 to 8.8 8.8 0.4m p ! 0.0005) at v2. Similar trends were seen with dual but not with PEG. With OSPS in SCI subjects, changes in serum P (increase) and Ca (decrease) were similar to AB subjects without significant change in urinary P or NAG. Conclusion: Ingestion of OSPS alone or in combination with PEG resulted in elevation of serum P with decrease in Ca in AB and SCI subjects. Transient, but clinically insignificant, deterioration of renal function occurs in AB subjects. SCI subjects are less predisposed to this toxicity of OSPS and use of OSPS appears to be safe for routine C in them.