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P249 Usefulness of abdominal ultrasonography for patency assessment using the patency capsule

Ishii M.*1, Nasuno M.2, Tanaka H.2, Motoya S.2, Miyakawa M.2, Sugiyama K.2, Honda K.3, Matsumoto H.1, Fujita M.1, Manabe N.4, Hata J.4, Shiotani A.1

1Kawasaki Medical School, Division of Gastroenterology Department of Internal Medicine, Kurashiki, Japan 2Sapporo Kosei General Hospital, IBD Center, Sapporo, Japan 3Kawasaki Medical School, Genaral Medicine, Kurashiki, Japan 4Kawasaki Medical School, Clinical Pathology and Laboratory Medicine, Kurashiki, Japan

Background

The present study was undertaken to evaluate the usefulness of abdominal ultrasonography (US) in patency assessment using the patency capsule (PC).

Methods

This study involved 223 patients (139 men, mean age 39.9) for whom patency assessment using the PC was planned for capsule endoscopy (CE) at 2 domestic hospitals between August 2012 and August 2016. We excluded patients with ileus, those found to have small bowel stenosis on x-ray photography (XP) or US, and patients with apparently severe stenosis of the large bowel. Patency was judged on the basis of the morphology of the PC re-collected within 30–33 hours after oral PC intake. In cases in which PC re-collection was not possible, XP was performed approximately 33 hours later and, if localization of the PC by XP was difficult, abdominal computed tomography (CT) was additionally performed. In patients for whom patency was confirmed, CE was carried out within several days after confirmation of patency using PC. Complications, including CE retention, were analyzed.

Results

The 223 patients studied included 144 with Crohn's disease, 16 with unexplained enteritis and 63 with other reasons for undergoing this examination. PC tests were performed for 268 sessions in total for the 223 patients. Oral PC intake was not possible in 6 cases. Of these 6 cases, 2 received the PC test with endoscopy and 4 withdrew from the study. Of the 264 cases in whom patency was assessed using the PC, PC excretion was visually documented in 174. There were 12 cases in whom the PC was shown to be present in the large bowel by XP, 51 cases in whom PC localization by XP was difficult, and 27 cases in whom excretion of the PC was confirmed by XP. The latter 27 cases were excluded from analysis because morphological evaluation of the PC was not possible. US was performed on 51 cases for whom localization of the PC had been difficult. Among these 51 cases, US revealed PC within the small bowel in 16 and presence of the PC in the large bowel in 32 cases. In the remaining 3 cases, US assessment was difficult, and CT was additionally performed, allowing confirmation of presence of the PC in the large bowel in all of these cases. CE was skipped in the 16 cases found by US to have PC within the small bowel, and CE was performed in the other 35 cases. Of the 221 cases in whom patency was confirmed with the PC, 220 underwent CE (1 case declined CE). No complications, such as CE retention, occurred in any of these patients.

Conclusion

Among the 268 cases receiving the PC test, localization of the PC by XP was difficult in 51, but localization by US was possible in 48 of these 51 cases, allowing avoidance of CT scanning. These results suggest US to be useful for patency assessment using the PC.