Accuracy of the Patency Capsule to Exclude Small Bowel Strictures in Crohnʼs Disease: Is it Better to be Safe or Sorry?
Notice bibliographique
Résumé
Purpose: Capsule endoscopy (CE) is now a well established investigation for suspected Crohn's disease (CD). Its use in established CD has been limited, due in part to the relatively high risk (˜5%) of capsule retention. Barium radiography (SBFT) has not been found to be reliable to assure small bowel patency prior to CE in CD. The use of a patency capsule has thus been proposed as an alternate screening test for this purpose. Evacuation of the dummy capsule from the small bowel within a 30 h window indicates small bowel patency, whereas its retention beyond this time has been taken to imply a potential luminal stricture, contraindicating CE. The purpose of this study was to evaluate the clinical utility and safety of the patency capsule in established CD. Methods: Outcomes of consecutive CD cases referred for CE were reviewed before and after the systematic use of a patency capsule to screen for small bowel patency. Plain abdominal radiology (AxR) was used to localize the patency capsule 30 +/− 2 hr after ingestion. Results: Before the FDA approved introduction of the Agile patency capsule in 2006, we carried out small bowel CE in 31 CD patients without obstructive symptoms or any strictures seen on SBFT. Capsule retention occurred in 2 (6.7%) of these cases. Subsequently, 37 consecutive CD patients first underwent the patency capsule exam. Among these, 5 were denied CE because the patency capsule was localized to the small bowel radiologically 30 h after ingestion. Among the 32 others who underwent the CE exam, capsule retention occurred in 1 (3.2%) case. For the most recent 4 CD patients in whom the patency capsule position was deemed to be in the small bowel or its location was doubtful at 30 h, a second AxR was carried out at 48-60 h. In 3 of the latter, the repeat imaging showed that the patency capsule was eliminated intact from the small bowel. All 3 subsequently underwent a successful CE exam. CE was denied in the 1 remaining case with prolonged small bowel retention of the patency capsule. Conclusion: Subclinical intestinal stenoses are frequent in CD and conventional radiologic investigations have a low sensitivity for their detection. Use of a patency capsule use appears to reduce, but not completely eliminate the risk of capsule retention. However, the “safe” reliance on a 30 hour cut-off for patency capsule elimination from the small bowel may preclude a clinically worthwhile CE study. Further trials are required to validate the safety and clinical value of a delayed cut-off (˜48 hr) for intact patency capsule passage. Disclosure: Dr Ernest G Seidman- Consultant, member of Speaker's Bureau, and recipeint of research support from Given Imaging Inc. Given Imaging Inc. supplied a small number of patency capsules free of charge.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,014 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».