Capsule retention in Crohn’s lower than previously thought
Lower than expected retention rates for capsule endoscopy devices revealed in a meta-analysis could be due to diligent assessment of small bowel patency, according to study authors.
Shabana F. Pasha, MD, from the Mayo Clinic in Scottsdale, Arizona, and colleagues wrote that although retention is considered a relatively minor adverse event in capsule endoscopy, it is still a barrier to its wider use.
“Patients are usually asymptomatic, and in about one-third, the capsule is naturally excreted later than 15 days after ingestion,” they wrote. “Nevertheless, in some patients it can result in acute obstruction or perforation.”
Researchers wanted to evaluate capsule retention rates in both established (ECD) and suspected (SCD) Crohn’s disease using real-world data and determine if retention risk was mitigated by the use of patency capsules or magnetic resonance/computed tomography.
They searched the literature for studies that reported retention and estimated pooled estimates retention rates and relative risk in patients with either ECD or SCD.
Across 35 studies, researchers found that the overall retention rate was 3.32% (95% CI; 2.62%–4.2%). Rates were higher for ECD (4.63%; 95% CI, 3.42%–6.25%) compared with SCD (2.35%; 95% CI, 1.31%–4.19%), and patients with ECD were 3.5 times more likely to experience retention (95% CI, 2.12–5.78).
Retention rates were lower among pediatric patients (1.64%; 95 % CI, 0.68%–3.89%), and there was no difference in risk between pediatric ECD and SCD.
Pasha and colleagues wrote that retention rates in clinical practice are lower than those found in previous studies. They wrote that this is likely due to careful use of small bowel patency testing when indicated. In their analysis, researchers found that retention rates for ECD were decreased after patency capsule (2.88%; 95% CI, 1.74%–4.74%) and MR/CT enterography (2.32%; 95% CI, 0.87%–6.03%).
“Our meta-analysis confirms the utility of [patency capsule] and cross-sectional imaging in lowering [capsule endoscopy] retention in established CD,” Pasha and colleagues concluded. – by Alex Young
Disclosures: Pasha reports consulting and research support from Medtronic. Please see the full study for all other authors’ relevant financial disclosures.