Accuracy of the Patency Capsule to Exclude Small Bowel Strictures in Crohnʼs Disease: Is it Better to be Safe or Sorry?
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".